OBJECTIVES: Assisted reproductive technologies (ARTs) are well-established treatments for many types of subfertility. Current treatment regimens prescribe daily injections of FSH (urinary FSH or recombinant FSH (rFSH)). Corifollitropin alfa (CRFa) is a new long-acting FSH which can replace seven daily FSH injections during the first week of controlled ovarian stimulation. This study was aimed to compare the effectiveness of CRFa versus rFSH in terms of pregnancy and safety outcomes in women undergoing ARTs.

METHODS: A systematic review was conducted in major databases including PubMed, Cochrane, Embase, Google scholar, and Web of Science up to June 2018 with limitation to English full-text published articles. Data extraction and assessment of risk of bias was independently done by two review authors. Mantel-Henszel odds ratios (OR) and standardized mean differences (SMD) were calculated for outcomes. The primary outcomes were live birth rate, ovarian hyperstimulation syndrome (OHSS) rate, the number of oocytes retrieved, and the number of embryos transferred. Meta-analysis was performed using RevMan 5.3 software.

RESULTS: The study examined nine RCTs including 2407 patients receiving CRFa and 2056 women receiving daily rFSH. Although women receiving CRFa had a significantly higher number of oocyte retrieved (SMD: +0.25 , 95%CI: 0.11-0.39 ), number of metaphase II oocytes (SMD: +0.28 , 95%CI: 0.11-0.44 ), and number of embryos obtained (SMD: +0.27 , 95%CI: 0.13-0.41), in comparison to rFSH; there was a significant differences in the rate of embryos transferred in favor of rFSH (OR: 0.68 , 95%CI: 0.55–0.85 ). However, no significant differences between CRFa and rFSH was found with respect to the majority of clinical effectiveness and safety parameters considered including live birth rate, ongoing pregnancy rate, clinical pregnancy rate, miscarriage rate, and OHSS rate.

CONCLUSIONS: A single dose of CRFa for the first 7 days of ovarian stimulation is a generally well-tolerated and equally effective treatment compared with rFSH.