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Cevher Akdulum MF, Arık Sİ, Demirdağ E, Erdem M, Erdem A. In Vitro Fertilization Outcomes With a Dual Trigger in Normoresponders in Antagonist Cycles. Cureus 2023; 15:e45623. [PMID: 37868584 PMCID: PMC10588958 DOI: 10.7759/cureus.45623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2023] [Indexed: 10/24/2023] Open
Abstract
Objectives To evaluate whether the dual trigger of ovulation with a gonadotropin-releasing hormone (GnRH) agonist and the standard dose of recombinant human chorionic gonadotropin (hCG) (dual trigger) is better than hCG alone in in vitro fertilization (IVF) cycles of patients who responded well to ovarian stimulation. Methods Between January 2013 and December 2021, 5593 antagonist cycles of patients were reviewed. This study included women who had an antral follicle count of 5 or more and exhibited a normoresponse to ovarian stimulation using the GnRH antagonist protocol, as determined by the follicular output rate (FORT). The primary outcome indicators consisted of the quantities of retrieved oocytes and mature oocytes. The secondary outcome markers included live birth rates, clinical pregnancy rates, and continued pregnancy rates. Results A total of 1244 normoresponder women who met the inclusion criteria were identified from the scanned files and subsequently enrolled in the GnRH antagonist protocol. A total of 383 cycles were observed in the group that was given the standard hCG trigger while 861 cycles were observed in the group that was given the dual trigger. The number of mature oocytes and top-quality embryos was significantly higher in the dual trigger group. The maturation rate in the hCG group was 74.8% while it was 76.9% in the dual trigger group (p=0.018). The dual trigger group exhibited an ongoing pregnancy rate of 37.6%, whereas the hCG group had a rate of 30.1% (p = 0.02). The dual trigger group exhibited a slightly higher live birth rate (34.3% vs 29.2%, p = 0.11), although this difference did not reach statistical significance. Conclusion Dual trigger of ovulation was superior to hCG alone in terms of the number of mature oocytes yielded, top quality of embryos, maturation rates, and ongoing pregnancy in IVF cycles of normoresponders having ovarian stimulation on the GnRH antagonist protocol.
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Affiliation(s)
| | | | - Erhan Demirdağ
- Obstetrics and Gynecology, Gazi University, School of Medicine, Ankara, TUR
| | - Mehmet Erdem
- Obstetrics and Gynaecology, Gazi University, Ankara, TUR
| | - Ahmet Erdem
- Obstetrics and Gynecology, Gazi University, Ankara, TUR
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Venetis CA, Storr A, Chua SJ, Mol BW, Longobardi S, Yin X, D'Hooghe T. What is the optimal GnRH antagonist protocol for ovarian stimulation during ART treatment? A systematic review and network meta-analysis. Hum Reprod Update 2023; 29:307-326. [PMID: 36594696 PMCID: PMC10152179 DOI: 10.1093/humupd/dmac040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/09/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Several GnRH antagonist protocols are currently used during COS in the context of ART treatments; however, questions remain regarding whether these protocols are comparable in terms of efficacy and safety. OBJECTIVE AND RATIONALE A systematic review followed by a pairwise and network meta-analyses were performed. The systematic review and pairwise meta-analysis of direct comparative data according to the PRISMA guidelines evaluated the effectiveness of different GnRH antagonist protocols (fixed Day 5/6 versus flexible, ganirelix versus cetrorelix, with or without hormonal pretreatment) on the probability of live birth and ongoing pregnancy after COS during ART treatment. A frequentist network meta-analysis combining direct and indirect comparisons (using the long GnRH agonist protocol as the comparator) was also performed to enhance the precision of the estimates. SEARCH METHODS The systematic literature search was performed using Embase (Ovid), MEDLINE (Ovid), Cochrane Central Register of Trials (CENTRAL), SCOPUS and Web of Science (WOS), from inception until 23 November 2021. The search terms comprised three different MeSH terms that should be present in the identified studies: GnRH antagonist; assisted reproduction treatment; randomized controlled trial (RCT). Only studies published in English were included. OUTCOMES The search strategy resulted in 6738 individual publications, of which 102 were included in the systematic review (corresponding to 75 unique studies) and 73 were included in the meta-analysis. Most studies were of low quality. One study compared a flexible protocol with a fixed Day 5 protocol and the remaining RCTs with a fixed Day 6 protocol. There was a lack of data regarding live birth when comparing the flexible and fixed GnRH antagonist protocols or cetrorelix and ganirelix. No significant difference in live birth rate was observed between the different pretreatment regimens versus no pretreatment or between the different pretreatment protocols. A flexible GnRH antagonist protocol resulted in a significantly lower OPR compared with a fixed Day 5/6 protocol (relative risk (RR) 0.76, 95% CI 0.62 to 0.94, I2 = 0%; 6 RCTs; n = 907 participants; low certainty evidence). There were insufficient data for a comparison of cetrorelix and ganirelix for OPR. OCP pretreatment was associated with a lower OPR compared with no pretreatment intervention (RR 0.79, 95% CI 0.69 to 0.92; I2 = 0%; 5 RCTs, n = 1318 participants; low certainty evidence). Furthermore, in the network meta-analysis, a fixed protocol with OCP resulted in a significantly lower OPR than a fixed protocol with no pretreatment (RR 0.84, 95% CI 0.71 to 0.99; moderate quality evidence). The surface under the cumulative ranking (SUCRA) scores suggested that the fixed protocol with no pretreatment is the antagonist protocol most likely (84%) to result in the highest OPR. There was insufficient evidence of a difference between fixed/flexible or OCP pretreatment/no pretreatment interventions regarding other outcomes, such as ovarian hyperstimulation syndrome and miscarriage rates. WIDER IMPLICATIONS Available evidence, mostly of low quality and certainty, suggests that different antagonist protocols should not be considered as equivalent for clinical decision-making. More trials are required to assess the comparative effectiveness of ganirelix versus cetrorelix, the effect of different pretreatment interventions (e.g. progestins or oestradiol) or the effect of different criteria for initiation of the antagonist in the flexible protocol. Furthermore, more studies are required examining the optimal GnRH antagonist protocol in women with high or low response to ovarian stimulation.
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Affiliation(s)
- C A Venetis
- University of New South Wales, Faculty of Medicine & Health, Centre for Big Data Research in Health & Discipline of Obstetrics and Gynaecology, Sydney, Australia.,IVFAustralia, Alexandria, NSW, Australia
| | - A Storr
- Flinders Fertility, Adelaide, SA, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - S J Chua
- Austin Health, Heidelberg, Australia
| | - B W Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
| | - S Longobardi
- Global Clinical Development, Merck Serono S.p.A, Rome, Italy, an affiliate of Merck KGaA
| | - X Yin
- EMD Serono Inc., R&D Global Biostatistics, Epidemiology & Medical Writing, Billerica, MA, USA, an affiliate of Merck KGaA
| | - T D'Hooghe
- Merck Healthcare KGaA, Darmstadt, Germany.,Department of Development and Regeneration, Laboratory of Endometrium, Endometriosis & Reproductive Medicine, KU Leuven, Leuven, Belgium.,Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University Medical School, New Haven, CT, USA
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Mutlu I, Demirdag E, Cevher F, Erdem A, Erdem M. Dual trigger with the combination of gonadotropin-releasing hormone agonist and standard dose of human chorionic gonadotropin improves in vitro fertilisation outcomes in poor ovarian responders. J OBSTET GYNAECOL 2021; 42:1239-1244. [PMID: 34565274 DOI: 10.1080/01443615.2021.1945560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The study aimed to evaluate the impact of the dual trigger with the combination of GnRH agonist and standard dose of recombinant hCG on IVF outcomes in poor ovarian responders with GnRH antagonist protocol. 1283 cycles of 1010 poor responder patients according to Bologna criteria were retrospectively analysed in terms of final oocyte maturation: dual trigger group (250 μg hCG + 0.2 mg triptorelin) or standard group (250 μg hCG). Primary outcome measures were the number of retrieved and mature oocytes. The secondary outcome measures were clinical pregnancy rates and live birth rates.The number of retrieved oocytes, mature oocytes, and the top-quality embryos transferred were significantly higher in the dual trigger group (p < .001). Fertilisation rates (73.6% vs 69.6%, p = .009), implantation rates (18.7% vs 14.6, p = .039), clinical pregnancy rate per embryo transfer (27.5% vs. 19.9%, p = .010) and live birth rate per embryo transfer (21.6% vs. 14.9%, p = .011) were also significantly higher in the dual trigger group as compared to the hCG trigger group. The usage of dual trigger with a GnRH agonist and a standard dosage of hCG could improve clinical pregnancy rates and live birth rates in poor ovarian responders undergoing GnRH antagonist IVF/ICSI cycles.IMPACT STATEMENTWhat is already known on this subject? Dual trigger with standard dose of hCG has been the subject of trials in normal responders to optimise IVF outcomes. The results of these studies showed significant improvements in implantation and pregnancy rates with an increase in the number of mature oocytes retrieved. As a result, dual trigger has become a popular ovulation trigger option in GnRH antagonist cycles.What do the results of this study add? There is limited data about the use of dual trigger in poor ovarian responders (PORs). According to our study, increasing the number of retrieved oocytes, mature oocytes, the number of fertilised oocytes, the number of transferred embryos and top quality embryos transferred by using dual trigger in patients with PORs have a positive impact on pregnancy outcomes.What are the implications of these findings for clinical practice and/or further research? These findings implies potential advantages of dual trigger usage for improving IVF outcomes in PORs. With large sample sized prospective randomised trials, dual trigger with combination of GnRHa and a standard dose of hCG might replace the traditional ovulation trigger with hCG in PORs.
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Affiliation(s)
- Ilknur Mutlu
- IVF Unit, Novaart IVF and Women Health Center, Ankara, Turkey
| | - Erhan Demirdag
- Department of Obstetrics & Gynecology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Funda Cevher
- Department of Obstetrics & Gynecology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Ahmet Erdem
- Department of Obstetrics & Gynecology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Mehmet Erdem
- Department of Obstetrics & Gynecology, Gazi University Faculty of Medicine, Ankara, Turkey
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Yang J, Zhang X, Ding X, Wang Y, Huang G, Ye H. Cumulative live birth rates between GnRH-agonist long and GnRH-antagonist protocol in one ART cycle when all embryos transferred: real-word data of 18,853 women from China. Reprod Biol Endocrinol 2021; 19:124. [PMID: 34384445 PMCID: PMC8359059 DOI: 10.1186/s12958-021-00814-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 07/31/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND A consensus has been reached on the preferred primary outcome of all infertility treatment trials, which is the cumulative live birth rate (CLBR). Some recent randomized controlled trials (RCTs) and retrospective studies have compared the effectiveness of GnRH-antagonist and GnRH-agonist protocols but showed inconsistent results. Studies commonly used conservative estimates and optimal estimates to described the CLBR of one incomplete assisted reproductive technology (ART) cycle and there are not many previous studies with data of the complete cycle to compare CLBRs in GnRH-antagonist versus GnRH-agonist protocols. METHODS A total of 18,853 patients have completed their first IVF cycle including fresh and subsequent frozen-thawed cycles during 2016-2019, 16,827 patients were treated with GnRH-a long and 2026 patients with GnRH-ant protocol. Multivariable logistic analysis was used to evaluate the difference of GnRH-a and GnRH-ant protocol in relation to CLBR. Utilized Propensity Score Matching(PSM) for sampling by up to 1:1 nearest neighbor matching to adjust the numerical difference and balance the confounders between groups. RESULTS Before PSM, significant differences were observed in baseline characteristics and the CLBR was 50.91% in the GnRH-a and 33.42% in the GnRH-ant (OR = 2.07; 95%CI: 1.88-2.28; P < 0.001). Stratified analysis showed the CLBR of GnRH-ant was lower than GnRH-a in suboptimal responders(46.89 vs 27.42%, OR = 2.34, 95%CI = 1.99-2.74; P < 0.001) and no differences of CLBR were observed in other patients between protocols. After adjusting for potential confounders, multivariable logistic analysis found the CLBR of GnRH-ant group was lower than that of GnRH-a group (OR = 2.11, 95%CI:1.69-2.63, P < 0.001). After PSM balenced the confounders between groups, the CLBR of GnRH-a group was higher than that of GnRH-ant group in suboptimal responders((38.61 vs 28.22%, OR = 1.60, 95%CI = 1.28-1.99; P < 0.001) and the normal fertilization rate and number of available embryo in GnRH-a were higher than these of GnRH-ant groups in suboptimal responders (77.39 vs 75.22%; 2.86 ± 1.26 vs 2.61 ± 1.22; P < 0.05). No significant difference was observed in other patients between different protocols. CONCLUSIONS It is crucial to optimize the utilization of protocols in different ovarian response patients and reconsider the field of application of GnRH-ant protocols in China.
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Affiliation(s)
- Jingwei Yang
- Chongqing Key Laboratory of Human Embryo Engineering, Chongqing, China
- Chongqing Clinical Research Center for Reproductive Medicine, Chongqing, China
| | - Xiaodong Zhang
- Chongqing Key Laboratory of Human Embryo Engineering, Chongqing, China
- Reproductive and Genetic Institute, Chongqing Health Center for Women and Children, No. 64 Jin Tang Street, Yu Zhong District, Chongqing, 400013, China
| | - Xiaoyan Ding
- Chongqing Key Laboratory of Human Embryo Engineering, Chongqing, China
- Chongqing Clinical Research Center for Reproductive Medicine, Chongqing, China
| | - Yuting Wang
- The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Guoning Huang
- Chongqing Key Laboratory of Human Embryo Engineering, Chongqing, China
- Chongqing Clinical Research Center for Reproductive Medicine, Chongqing, China
- Reproductive and Genetic Institute, Chongqing Health Center for Women and Children, No. 64 Jin Tang Street, Yu Zhong District, Chongqing, 400013, China
| | - Hong Ye
- Chongqing Key Laboratory of Human Embryo Engineering, Chongqing, China.
- Chongqing Clinical Research Center for Reproductive Medicine, Chongqing, China.
- Reproductive and Genetic Institute, Chongqing Health Center for Women and Children, No. 64 Jin Tang Street, Yu Zhong District, Chongqing, 400013, China.
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Ding X, Yang J, Li L, Yang N, Lan L, Huang G, Ye H. Fertility outcomes in women after controlled ovarian stimulation with gonadotropin releasing hormone agonist long protocol: fresh versus frozen embryo transfer. BMC Pregnancy Childbirth 2021; 21:207. [PMID: 33711956 PMCID: PMC7955631 DOI: 10.1186/s12884-021-03698-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 03/05/2021] [Indexed: 11/24/2022] Open
Abstract
Background Along with progress in embryo cryopreservation, especially the vitrification, freeze all strategy has become more acceptable than ever. Some studies have found comparable or higher live birth rate with frozen embryo transfer (FET) than with fresh embryo transfer(ET)in gonadotropin releasing hormone antagonist (GnRH-ant) protocol. However from our literature research, there have been no reports about live birth rate comparison between fresh ET and FET with gonadotropin releasing hormone agonist (GnRH-a) long protocol. The aim of this study is to retrospectively investigate whether patients benefit from freeze all strategy in GnRH-a protocol using real-world data. Methods This is a retrospective cohort study, in which women undergoing fresh ET or FET with GnRH-a long protocol at Chongqing Reproductive and Genetics Institute from January 2016 to December 2018 were evaluated. The primary outcome was live birth rate. The secondary outcomes were implantation rate, clinical pregnancy rate, pregnancy loss and ectopic pregnancy rate. Results A total of 7,814 patients met inclusion criteria, implementing 5,216 fresh ET cycles and 2,598 FET cycles, respectively. The demographic characteristics of the patients were significantly different between fresh ET and FET groups, except BMI. After controlling for a broad range of potential confounders including age, infertility duration, BMI, AMH, number of oocytes retrieved and of available embryos, multivariate logistic regression analysis demonstrated that there was no significant difference in clinical pregnancy rate, ectopic pregnancy rate and pregnancy loss rate between two groups (all P > 0.05). However, the implantation rate and live birth rate in fresh ET group were significantly higher than FET group (P < 0.001 and P = 0.012, respectively). Conclusions Under GnRH-a long protocol, compared to FET, fresh ET was associated with higher implantation rate and live birth rate in infertile patients that underwent in vitro fertilization (IVF). The freeze all strategy should be individualized and made with caution especially with GnRH-a long protocol.
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Affiliation(s)
- Xiaoyan Ding
- Chongqing Key Laboratory of Human Embryo Engineering, Chongqing Clinical Research Center for Reproductive Medicine, Reproductive and Genetics Institute, Chongqing Health Center for Women and Children, 400013, Chongqing, China
| | - Jingwei Yang
- Chongqing Key Laboratory of Human Embryo Engineering, Chongqing Clinical Research Center for Reproductive Medicine, Reproductive and Genetics Institute, Chongqing Health Center for Women and Children, 400013, Chongqing, China
| | - Lan Li
- Chongqing Key Laboratory of Human Embryo Engineering, Chongqing Clinical Research Center for Reproductive Medicine, Reproductive and Genetics Institute, Chongqing Health Center for Women and Children, 400013, Chongqing, China
| | - Na Yang
- Chongqing Key Laboratory of Human Embryo Engineering, Chongqing Clinical Research Center for Reproductive Medicine, Reproductive and Genetics Institute, Chongqing Health Center for Women and Children, 400013, Chongqing, China
| | - Ling Lan
- Chongqing Key Laboratory of Human Embryo Engineering, Chongqing Clinical Research Center for Reproductive Medicine, Reproductive and Genetics Institute, Chongqing Health Center for Women and Children, 400013, Chongqing, China
| | - Guoning Huang
- Chongqing Key Laboratory of Human Embryo Engineering, Chongqing Clinical Research Center for Reproductive Medicine, Reproductive and Genetics Institute, Chongqing Health Center for Women and Children, 400013, Chongqing, China
| | - Hong Ye
- Chongqing Key Laboratory of Human Embryo Engineering, Chongqing Clinical Research Center for Reproductive Medicine, Reproductive and Genetics Institute, Chongqing Health Center for Women and Children, 400013, Chongqing, China.
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Wertheimer A, Danieli-Gruber S, Hochberg A, Oron G, Sapir O, Shufaro Y, Ben-Haroush A. The association between treatment parameters on the day of gonadotropin-releasing hormone antagonist initiation during a flexible protocol and oocyte maturation rate. Reprod Biol 2020; 20:127-131. [PMID: 32354575 DOI: 10.1016/j.repbio.2020.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 04/12/2020] [Accepted: 04/17/2020] [Indexed: 10/24/2022]
Abstract
This study aimed to evaluate the effects of different treatment parameters on the day of GnRH antagonist initiation on oocyte maturation rate. We performed a retrospective cohort study of women aged ≤ 38 who underwent their first IVF-ICSI treatment using a flexible GnRH antagonist protocol in a single university-affiliated medical center during 2005-2015. Treatment parameters of three groups of oocyte maturation rates (<60%, 60-90%,>90%) were compared. Multivariate analysis was conducted to detect an association between treatment parameters on the day of GnRH antagonist initiation and oocyte maturation rate. The cohort included 458 patients, of whom 180 (39%) had a high oocyte maturation rate (≥90%), 211 (46%) had an oocyte maturation rate between 60-90% and 67 (15%) had a low maturation rate (≤60%). Women with a high maturation rate had longer duration of treatment (10.3 ± 2.9 days vs. 9.6 ± 2.5 vs. 9.5 ± 3.2, P = 0.019), lower levels of estradiol (1985 ± 1357 vs. 2406 ± 1666 vs. 2325 ± 1811, P = 0.027) and lower estradiol/maximal follicular diameter ratio on the day of GnRH antagonist initiation (137 ± 89 vs. 165 ± 103 vs. 163 ± 125, P = 0.019) as compared to women with medium and low maturation rates, respectively. Using linear regression multivariate analysis, lower estradiol and lower estradiol/maximal follicular diameter ratio on GnRH antagonist initiation day were associated with higher oocyte maturation rate. Further prospective studies to determine the best timing for GnRH antagonist initiation are needed.
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Affiliation(s)
- Avital Wertheimer
- IVF and Infertility Unit, Helen Schneider Hospital for Women, Rabin Medical Center-Beilinson Hospital, Petach Tikva, 4941492, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6901128, Israel.
| | - Shir Danieli-Gruber
- IVF and Infertility Unit, Helen Schneider Hospital for Women, Rabin Medical Center-Beilinson Hospital, Petach Tikva, 4941492, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6901128, Israel
| | - Alyssa Hochberg
- IVF and Infertility Unit, Helen Schneider Hospital for Women, Rabin Medical Center-Beilinson Hospital, Petach Tikva, 4941492, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6901128, Israel
| | - Galia Oron
- IVF and Infertility Unit, Helen Schneider Hospital for Women, Rabin Medical Center-Beilinson Hospital, Petach Tikva, 4941492, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6901128, Israel
| | - Onit Sapir
- IVF and Infertility Unit, Helen Schneider Hospital for Women, Rabin Medical Center-Beilinson Hospital, Petach Tikva, 4941492, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6901128, Israel
| | - Yoel Shufaro
- IVF and Infertility Unit, Helen Schneider Hospital for Women, Rabin Medical Center-Beilinson Hospital, Petach Tikva, 4941492, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6901128, Israel
| | - Avi Ben-Haroush
- IVF and Infertility Unit, Helen Schneider Hospital for Women, Rabin Medical Center-Beilinson Hospital, Petach Tikva, 4941492, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6901128, Israel
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Zanetti BF, Braga DPDAF, Setti AS, Iaconelli A, Borges E. Effect of GnRH analogues for pituitary suppression on oocyte morphology in repeated ovarian stimulation cycles. JBRA Assist Reprod 2020; 24:24-29. [PMID: 31436072 PMCID: PMC6993161 DOI: 10.5935/1518-0557.20190050] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE To compare the effect of pituitary suppression regimens on oocyte morphology in consecutive ICSI cycles of the same patients. METHODS Data was obtained from 200 matched consecutive intracytoplasmic sperm injection (ICSI) cycles performed in 100 couples undergoing the first cycle with the GnRH agonist and the following cycle with the GnRH antagonist regimen, from January 2010 to August 2016, in a private university-affiliated IVF centre. The effects of the pituitary suppression type on oocyte morphology were assessed by multivariate General Linear Models. RESULTS Mean interval between cycles was 185.32±192.85 days. Maternal age, body mass index, and total FSH dose administered were similar in both patients' cycles. Antagonist cycles presented lower incidence of dark cytoplasm (0.69±3.28% vs. 4.40±17.70%, p=0.047), Smooth endoplasmic reticulum (SER cluster (4.37±11.62% vs. 7.36±17.17%, p=0.046), and ZP defects (6.05±14.76% vs. 11.84±25.13%, p=0.049). Similar numbers of follicles retrieved oocytes, and mature oocytes were observed between the GnRH groups, as well as the fertilisation rate, number of obtained embryos, high-quality embryo rates, and the clinical outcomes. CONCLUSION GnRH antagonist's inhibitory effect on the ovaries in consecutive ICSI cycles results in improved oocyte maturity and morphology, despite similar laboratory and clinical outcomes, compared to the GnRH agonist treatment.
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Affiliation(s)
- Bianca Ferrarini Zanetti
- Fertility Medical Group, São Paulo, SP - Brazil.,Instituto Sapientiae - Centro de Estudos e Pesquisa em Reprodução Humana Assistida, São Paulo, SP - Brazil
| | - Daniela Paes de Almeida Ferreira Braga
- Fertility Medical Group, São Paulo, SP - Brazil.,Instituto Sapientiae - Centro de Estudos e Pesquisa em Reprodução Humana Assistida, São Paulo, SP - Brazil
| | - Amanda Souza Setti
- Fertility Medical Group, São Paulo, SP - Brazil.,Instituto Sapientiae - Centro de Estudos e Pesquisa em Reprodução Humana Assistida, São Paulo, SP - Brazil
| | - Assumpto Iaconelli
- Fertility Medical Group, São Paulo, SP - Brazil.,Instituto Sapientiae - Centro de Estudos e Pesquisa em Reprodução Humana Assistida, São Paulo, SP - Brazil
| | - Edson Borges
- Fertility Medical Group, São Paulo, SP - Brazil.,Instituto Sapientiae - Centro de Estudos e Pesquisa em Reprodução Humana Assistida, São Paulo, SP - Brazil
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Alecsandru D, Pacheco A, Guerrero-Mayo A, Fabris A, Aparicio P, Barrio A, Pellicer A, Garcia-Velasco JA. Ovarian stimulation does not influence the uterine immune environment in healthy infertile women. Reprod Biomed Online 2019; 40:113-123. [PMID: 31761720 DOI: 10.1016/j.rbmo.2019.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 07/15/2019] [Accepted: 08/14/2019] [Indexed: 10/26/2022]
Abstract
RESEARCH QUESTION There is some controversy regarding the impact of ovarian stimulation on immune cells in women undergoing IVF. The study's aim was to determine whether ovarian stimulation affected immune uterine cells in healthy women undergoing IVF. DESIGN This prospective cohort study included 28 patients undergoing IVF and 47 healthy oocyte donors. Endometrial biopsies were taken in a natural cycle and after ovarian stimulation. All participants had a normal karyotype, pelvic ultrasound and cervical cytology results and thyroid-stimulating hormone concentration, as well as normal glucose and insulin concentrations and inherited and acquired thrombophilia test results. Screening tests including human papillomavirus were normal. Immune cells were analysed using three techniques: fluorescence-activated cell sorting, immunohistochemistry and gene expression. A human leukocyte antigen (HLA)-C tetramer was used as an 'artificial embryo'. The expression of genes including those for tumour necrosis factor (TNF)-α and interleukin-10 (IL-10) was analysed. RESULTS A comparison was made of the percentage and gene expression of CD56brightCD16- uterine natural killer (uNK), CD56dimCD16+ natural killer cells, CD56-CD16+ natural killer cells and TregCD25+CD4+FoxP3+ cells, uNK binding to the HLA-C tetramer, and TNF-α and IL-10 expression. No between- or within-group differences were observed in natural versus ovarian stimulation cycles. CONCLUSIONS Ovarian stimulation does not affect the uterine immune cell population or HLA-C binding in healthy women undergoing ovarian stimulation. Further studies are underway to find out if different responses might be seen in women with previous autoimmune disorders.
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Affiliation(s)
- D Alecsandru
- Department of Immunology, IVI RMA, Madrid, Spain; Rey Juan Carlos University, Madrid, Spain; Health Research Institute La Fe, Valencia, Spain.
| | - A Pacheco
- Health Research Institute La Fe, Valencia, Spain; Department of Andrology, IVI RMA, Madrid, Spain; Alfonso X 'El Sabio' University, Madrid, Spain
| | | | - A Fabris
- Department of Reproductive Endocrinology and Infertility, IVI RMA, Madrid, Spain
| | - P Aparicio
- Department of Immunology, IVI RMA, Madrid, Spain
| | - A Barrio
- Department of Reproductive Endocrinology and Infertility, IVI RMA, Madrid, Spain
| | - A Pellicer
- Health Research Institute La Fe, Valencia, Spain; Universidad de Valencia, IVI Learning Center; Department of Reproductive Endocrinology and Infertility, IVI RMA, Roma, Italy
| | - Juan A Garcia-Velasco
- Rey Juan Carlos University, Madrid, Spain; Health Research Institute La Fe, Valencia, Spain; Universidad de Valencia, IVI Learning Center; Department of Reproductive Endocrinology and Infertility, IVI RMA, Madrid, Spain
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9
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Chen Q, Yu F, Li Y, Zhang AJ, Zhu XB. Comparative proteomics reveal negative effects of gonadotropin-releasing hormone agonist and antagonist on human endometrium. DRUG DESIGN DEVELOPMENT AND THERAPY 2019; 13:1855-1863. [PMID: 31239640 PMCID: PMC6554521 DOI: 10.2147/dddt.s201871] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 04/04/2019] [Indexed: 12/11/2022]
Abstract
Purpose: The two major ovarian-stimulation protocols for in vitro fertilization are gonadotropin-releasing hormone agonist (GnRH-a) protocol or GnRH antagonist (GnRH-ant) protocol; however, comparisons of their relative efficacy remain controversial. Additionally, conflicting data exist regarding their effects on endometrial receptivity. Thus, this study investigated how GnRH-a and GnRH-ant treatments alter the endometrium during the mid-secretory phase. Patients and methods: We compared proteomic profiles across human endometrium tissues of mid-secretory phase from normal control humans (n=5), patients treated with GnRH-a (n=5), and patients treated with GnRH-ant (n=5). Results: We identified 2088 proteins, with 362 that exhibited significantly different expression. Fuzzy c-means clustering (FCM) using the M Fuzz algorithm analysis showed that the same 87 proteins changed significantly in both the GnRH-a and GnRH-ant groups compared with those in the control. Moreover, Gene Ontology (GO) analysis showed that, of these 87, downregulated proteins were associated with energy metabolism and upregulated proteins were linked to cytoskeleton maintenance. Upregulated proteins involved in complement-mediated immunity were present in 151 proteins that exhibited significantly different expression in the GnRH-ant group only. Conclusion: We demonstrated that comparative proteomic analysis is useful for accessing endometrial receptivity, which seemed more strongly impaired by GnRH-ant than GnRH-a treatments. Our findings also revealed that energy metabolism and immunity response may be the key biological mechanisms underlying human endometrial receptivity.
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Affiliation(s)
- Qian Chen
- Center of Reproductive Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Feng Yu
- Interdisciplinary Science Research Institute, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Yan Li
- Center of Reproductive Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Ai-Jun Zhang
- Center of Reproductive Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Xiao-Bin Zhu
- Center of Reproductive Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
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Lyttle Schumacher BM, Mersereau JE, Steiner AZ. Cycle day, estrogen level, and lead follicle size: analysis of 27,790 in vitro fertilization cycles to determine optimal start criteria for gonadotropin-releasing hormone antagonist. Fertil Steril 2018; 109:633-637. [PMID: 29605403 DOI: 10.1016/j.fertnstert.2017.12.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 11/20/2017] [Accepted: 12/18/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To determine the optimal criteria at which to start GnRH antagonists during controlled ovarian hyperstimulation (COH) for in vitro fertilization (IVF). DESIGN Retrospective clinical cohort. SETTING IVF clinics. PATIENT(S) Women undergoing fresh autologous IVF using GnRH antagonist for ovulation suppression during COH. INTERVENTION(S) Measurement of lead follicle size, E2 level, and cycle day of stimulation on day of antagonist initiation. MAIN OUTCOME MEASURE(S) Clinical pregnancy rate (PR). RESULT(S) The highest clinical PR was achieved when the antagonist was started when a lead follicle reached 14-15.9 mm in size (mean clinical PR 21.3; 95% confidence interval [CI] 19.3, 23.6) on cycle day 6 (mean clinical PR 22.2; 95% CI 17, 28.4), or when the E2 level was between 500 and 599 pg/mL (mean clinical PR 25.4; 95% CI 19.5, 32.4). Starting antagonists when the E2 level was <300 or >1,100 pg/mL reduced the odds of clinical pregnancy by 40% (odds ratio 0.60, 95% CI 0.5, 0.7). CONCLUSION(S) Cycle day, E2 level, and follicle size at time of antagonist start are all independent predictors of a clinical pregnancy after IVF. Initiating antagonists when the E2 level is extremely low (<300 pg/mL) or extremely high (>1,100 pg/mL) significantly reduces the odds of pregnancy.
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Affiliation(s)
| | - Jennifer E Mersereau
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina
| | - Anne Z Steiner
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina
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11
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Wang AC, Wang Y, Wu FX, Zhu DY. Assessing predictors for the success of GnRH antagonist protocol in reproductive women in IVF/ICSI - in fresh cycles. Biomed Rep 2017; 7:482-486. [PMID: 29181162 DOI: 10.3892/br.2017.984] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 09/06/2017] [Indexed: 11/05/2022] Open
Abstract
The aim of the present study was to evaluate the factors that affect the success rate of gonadotropin-releasing hormone antagonist on in vitro fertilization/intracytoplasmic sperm injection cycles. Multivariate analysis was performed to assess the factors that influence the outcomes, such as oocytes retrieved, and the success of pregnancy. The results showed that E2, P on human chorionic gonadotropin (HCG) day and body mass index (BMI) were positively correlated with the number of oocytes retrieved (P=0.001, P=0.024, P=0.017, respectively). The duration of infertility as well as the luteinizing hormone on HCG day were negatively correlated with the number of oocytes (P=0.048, P=0.002, respectively). The age of the women and P on HCG day were negatively correlated with successful pregnancy (P<0.001, P=0.022). In conclusion, some parameters, such as E2, P, and LH on the HCG day, as well as age and BMI, may affect treatment outcomes.
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Affiliation(s)
- An-Cong Wang
- Department of Reproductive Medicine, Linyi People's Hospital, Linyi, Shandong 276003, P.R. China.,Department of Obstetrics and Gynecology, Linyi People's Hospital, Linyi, Shandong 276003, P.R. China
| | - Ying Wang
- Department of Gynecologic Oncology, Shandong Cancer Hospital and Institute, Jinan, Shandong 250117, P.R. China
| | - Feng-Xia Wu
- Department of Anatomy, Shandong University, Jinan, Shandong 250012, P.R. China
| | - Dong-Yi Zhu
- Department of Reproductive Medicine, Linyi People's Hospital, Linyi, Shandong 276003, P.R. China.,Department of Obstetrics and Gynecology, Linyi People's Hospital, Linyi, Shandong 276003, P.R. China
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12
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Prapas Y, Ravanos K, Petousis S, Panagiotidis Y, Papatheodorou A, Margioula-Siarkou C, Iuliano A, Gullo G, Prapas N. GnRH antagonist administered twice the day before hCG trigger combined with a step-down protocol may prevent OHSS in IVF/ICSI antagonist cycles at risk for OHSS without affecting the reproductive outcomes: a prospective randomized control trial. J Assist Reprod Genet 2017; 34:1537-1545. [PMID: 28776117 DOI: 10.1007/s10815-017-1010-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 07/21/2017] [Indexed: 10/19/2022] Open
Abstract
PURPOSE The purpose this study is to investigate whether a double antagonist dose (0.25 mg/12 h) administered the day before hCG trigger is effective in preventing ovarian hyperstimulation syndrome (OHSS) in GnRH antagonist IVF/intracytoplasmic sperm injection (ICSI) cycles at risk for OHSS. METHODS This is a prospective randomized control study, conducted from November 2012 to January 2016. A total of 194 patients undergoing a IVF/ICSI GnRH antagonist cycle that were at risk of OHSS and chose to proceed with embryo transfer and avoid cycle cancellation or embryo cryopreservation were allocated into two groups. The inclusion criteria consisted of a rapid rise of oestradiol ≥ 3500 pg/ml combined with ≥ 18 follicles > 11 mm in diameter without any mature follicle > 16 mm, in any day of stimulation. Overall, 97 patients (intervention group A) received a double dose of GnRH antagonist (0.25 mg/12 h) the day before hCG while 97 patients (control group B) did not. Recombinant FSH administration was tapered to 100 IU/24 h the day of the allocation in both groups. RESULTS Incidence of early-onset moderate/severe OHSS was significantly lower in intervention group A compared to control group B (0 vs 12.37%, P < 0.001). Clinical pregnancy rate per cycle (50.52 vs 42.27%, P = 0.249) was not significantly different between the two groups. Oestradiol (3263.471 ± 1271.53 vs 5233 ± 1425.17, P < 0.001), progesterone (0.93 ± 0.12 vs 1.29 ± 0.14, P < 0.001) and luteinizing hormone (1.42 ± 0.31 vs 1.91 ± 0.33, P < 0.001) were significantly lower in group A the day of the hCG triggering. CONCLUSION The administration of a rescue double GnRH antagonist dose the day before hCG trigger may represent a safe alternative preventive strategy for early OHSS without affecting the reproductive outcomes. TRIAL REGISTRATION NUMBER ISRCTN02750360.
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Affiliation(s)
- Yannis Prapas
- IAKENTRO Fertility Centre, Agiou Vasileiou 4, Thessaloniki, Greece
| | | | | | | | | | | | | | - Giuseppe Gullo
- Dipartimento di Ostetricia e Ginecologia, Policlinico P. Giaccone-Universita degli studi di Palermo, Palermo, Italy
| | - Nikos Prapas
- IAKENTRO Fertility Centre, Agiou Vasileiou 4, Thessaloniki, Greece
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13
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Şanverdi İ, Özkaya E, Kutlu T, Şenol T, Akalın M, Sayar Akalın E, Şahin Y, Karateke A. Non-invasive prediction of implantation window in controlled hyperstimulation cycles: Can the time from the menstrual day at embryo transfer to expected menstrual cycle give a clue? Turk J Obstet Gynecol 2016; 13:116-122. [PMID: 28913105 PMCID: PMC5558300 DOI: 10.4274/tjod.34651] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 08/06/2016] [Indexed: 12/31/2022] Open
Abstract
Objective: The aim of this study was to assess whether the time from the menstrual day at embryo transfer to expected menstrual cycle (TETEMC) is associated with the implantation in women with regular cycles or not. Materials and Methods: Forty women with successful implantation and forty women without implantation with regular cycles were randomly selected from prospectively collected database of assisted reproductive technology clinic of Zeynep Kamil Women And Children’s Health Training and Research Hospital. TETEMC was calculated for each case to assess relationship with the successful implantation. Results: Comparison of groups revealed significant differences with regard to TETEMC and the menstrual period (p<0.05). In ROC analyses both the TETEMC (AUC=0.824, p<0.001) and the menstrual period (AUC=0.797, p<0.001) were significant predictors for clinical pregnancy. Cut off value for the menstrual period was found to be 27.5 days with 82.6% sensitivity and 65% specificity. Cut off value for TETEMC was 11.5 days with 75% sensitivity and 63.2% specificity. Conclusion: Longer menstrual cycle and the TETEMC seem to be associated with the implantation failure.
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Affiliation(s)
- İlhan Şanverdi
- Zeynep Kamil Women and Children's Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Enis Özkaya
- Zeynep Kamil Women and Children's Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Tayfun Kutlu
- Zeynep Kamil Women and Children's Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Taylan Şenol
- Zeynep Kamil Women and Children's Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Munip Akalın
- Zeynep Kamil Women and Children's Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Eda Sayar Akalın
- Zeynep Kamil Women and Children's Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Yavuz Şahin
- Zeynep Kamil Women and Children's Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Ateş Karateke
- Zeynep Kamil Women and Children's Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
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14
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Bosch E, Labarta E, Kolibianakis E, Rosen M, Meldrum D. Regimen of ovarian stimulation affects oocyte and therefore embryo quality. Fertil Steril 2016; 105:560-570. [PMID: 26826273 DOI: 10.1016/j.fertnstert.2016.01.022] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 01/09/2016] [Accepted: 01/19/2016] [Indexed: 11/26/2022]
Abstract
Without any doubt the regimen used to mature multiple capable oocytes for IVF impacts IVF outcomes. Studies have indicated that the inclusion of LH activity, adjuvant agents such as growth hormone (GH), and regimens providing for simultaneous action of both LH and FSH during final oocyte maturation may have beneficial effects on IVF outcomes. Because of the difficulty in improving IVF outcomes in poor responders, the studies on GH are of particular interest. As pointed out in this review, the apparent beneficial effects of GH on oocyte competence may also apply to older women or to normal responders with reduced embryo quality. A much more difficult question is whether and how much ovarian stimulation impacts on oocyte competence. Paradoxically it seems that there are not demonstrated differences between the stimulated and the natural unstimulated cycle, whereas studies in laboratory animals and IVF patients have shown deleterious effects of higher compared with lower doses of gonadotropins. Recent studies suggest that the use of high doses of gonadotropins as an independent factor correlates negatively with the probability of live birth, whereas a high ovarian response per se is associated with better cumulative pregnancy rates, owing to the availability of more euploid and good-quality embryos. Although adjunctive use of androgens has not been discussed here, it is briefly covered in the first review of this series.
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Affiliation(s)
- Ernesto Bosch
- Instituto Valenciano de Infertilidad, Valencia, Spain.
| | - Elena Labarta
- Instituto Valenciano de Infertilidad, Valencia, Spain
| | - Efstratios Kolibianakis
- 1st Department of Obstetrics and Gynecology, Papageorgiou General Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Mitchell Rosen
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco School of Medicine, San Francisco, California
| | - David Meldrum
- Reproductive Partners La Jolla, San Diego, California
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15
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Samara N, Reis D, Danielli Miller N, Ghetler Y, Berkovitz A, Miller M, Gonen O, Shulman A, Wiser A. What are the best predictors for successful GnRH antagonist protocol in in vitro fertilization (IVF) treatment? Gynecol Endocrinol 2015; 31:877-9. [PMID: 26416777 DOI: 10.3109/09513590.2015.1081680] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To determine factors that affect the success rate of GnRH antagonist protocol in in vitro fertilization (IVF) treatment. DESIGN Retrospective cohort study. PATIENTS Patients who underwent IVF cycle with their first GnRH antagonist protocol. INTERVENTION Antagonist protocol during IVF treatment. The main outcome measurements were; Number of retrieved oocytes, embryo quality and pregnancy rate. RESULTS Gravidity was negatively correlated with number of eggs (p = 0.017), while total follicle number ≥15 (p = 0.044) and E(2) on day of human chorionic gonadotropin (HCG) (p = 0.000) had a positive correlation with number of eggs. Maximum follicle size at HCG administration showed a trend toward an inverse correlation (p = 0.053). Addition of LH to drug stimulation was negatively correlated with number of eggs in comparison to rFSH only (p = 0.013 and 0.0000, respectively). Age and number of frozen eggs were negatively correlated with successful pregnancy (p = 0.025 and 0.004, respectively), while embryo quality, gravidity and number of embryos were positive (p = 0.011 and 0.014, respectively). CONCLUSION Controlled parameters like timing of antagonist start, duration of antagonist and the optimal leading follicle diameter for HCG triggering had no effect on treatment outcomes.
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Affiliation(s)
- Nivin Samara
- a IVF Unit, Department of Obstetrics and Gynecology , Meir Medical Center , Kfar Saba , Israel , affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv , Israel
| | - Daniel Reis
- a IVF Unit, Department of Obstetrics and Gynecology , Meir Medical Center , Kfar Saba , Israel , affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv , Israel
| | - Netanella Danielli Miller
- a IVF Unit, Department of Obstetrics and Gynecology , Meir Medical Center , Kfar Saba , Israel , affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv , Israel
| | - Yehudith Ghetler
- a IVF Unit, Department of Obstetrics and Gynecology , Meir Medical Center , Kfar Saba , Israel , affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv , Israel
| | - Arie Berkovitz
- a IVF Unit, Department of Obstetrics and Gynecology , Meir Medical Center , Kfar Saba , Israel , affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv , Israel
| | - Moses Miller
- a IVF Unit, Department of Obstetrics and Gynecology , Meir Medical Center , Kfar Saba , Israel , affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv , Israel
| | - Ofer Gonen
- a IVF Unit, Department of Obstetrics and Gynecology , Meir Medical Center , Kfar Saba , Israel , affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv , Israel
| | - Adrian Shulman
- a IVF Unit, Department of Obstetrics and Gynecology , Meir Medical Center , Kfar Saba , Israel , affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv , Israel
| | - Amir Wiser
- a IVF Unit, Department of Obstetrics and Gynecology , Meir Medical Center , Kfar Saba , Israel , affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv , Israel
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16
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Esinler I, Bozdag G, Esinler D, Lale KS, Yarali H. Luteal-long GnRH agonist versus flexible-multidose GnRH antagonist protocols for overweight and obese patients who underwent ICSI. J OBSTET GYNAECOL 2014; 35:297-301. [DOI: 10.3109/01443615.2014.958439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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17
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Meng Y, Guo Y, Qian Y, Guo X, Gao L, Sha J, Cui Y, Chian RC, Liu J. Effects of GnRH antagonist on endometrial protein profiles in the window of implantation. Proteomics 2014; 14:2350-9. [PMID: 25065715 DOI: 10.1002/pmic.201400145] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 06/24/2014] [Accepted: 07/23/2014] [Indexed: 11/09/2022]
Affiliation(s)
- Yan Meng
- State key Laboratory of Reproductive Medicine; Clinical Center of Reproductive Medicine, the First Affiliated Hospital of Nanjing Medical University; Nanjing P. R. China
| | - Yueshuai Guo
- State Key Laboratory of Reproductive Medicine; Department of Histology and Embryology; Nanjing Medical University; Nanjing P. R. China
| | - Yi Qian
- State key Laboratory of Reproductive Medicine; Clinical Center of Reproductive Medicine, the First Affiliated Hospital of Nanjing Medical University; Nanjing P. R. China
| | - Xuejiang Guo
- State Key Laboratory of Reproductive Medicine; Department of Histology and Embryology; Nanjing Medical University; Nanjing P. R. China
| | - Li Gao
- State key Laboratory of Reproductive Medicine; Clinical Center of Reproductive Medicine, the First Affiliated Hospital of Nanjing Medical University; Nanjing P. R. China
| | - Jiahao Sha
- State Key Laboratory of Reproductive Medicine; Department of Histology and Embryology; Nanjing Medical University; Nanjing P. R. China
| | - Yugui Cui
- State key Laboratory of Reproductive Medicine; Clinical Center of Reproductive Medicine, the First Affiliated Hospital of Nanjing Medical University; Nanjing P. R. China
| | - Ri-Cheng Chian
- State key Laboratory of Reproductive Medicine; Clinical Center of Reproductive Medicine, the First Affiliated Hospital of Nanjing Medical University; Nanjing P. R. China
| | - Jiayin Liu
- State key Laboratory of Reproductive Medicine; Clinical Center of Reproductive Medicine, the First Affiliated Hospital of Nanjing Medical University; Nanjing P. R. China
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18
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Xiao J, Chang S, Chen S. The effectiveness of gonadotropin-releasing hormone antagonist in poor ovarian responders undergoing in vitro fertilization: a systematic review and meta-analysis. Fertil Steril 2013; 100:1594-601.e1-9. [PMID: 24055048 DOI: 10.1016/j.fertnstert.2013.08.024] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2013] [Revised: 08/14/2013] [Accepted: 08/15/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of gonadotropin-releasing hormone (GnRH) antagonist in poor ovarian responders undergoing in vitro fertilization (IVF). DESIGN Systematic review and meta-analysis. SETTING Affiliated hospital with a medical university. PATIENT(S) None. INTERVENTION(S) Electronic search. MAIN OUTCOME MEASURE(S) Clinical pregnancy rate, number of oocytes retrieved, cycle cancellation rate. RESULT(S) A total of 12 published studies (1,332 cases) were included. Both the stimulation period (mean difference [MD], -0.43; 95% confidence interval [CI], -0.68 to -0.17) and the gonadotropin dosage (MD, -5.41; 95% CI, -7.51 to -3.31) were statistically significantly lower in the GnRH antagonist protocol than in the long GnRH agonist protocol. Both the endometrial thickness (MD -0.45; 95% CI, -0.76 to -0.13) and estrogen (E2) level on the day of hCG administration (MD, -1,299.15; 95% CI, -1,716.34 to -881.95) were statistically significantly lower in the GnRH antagonist protocol than the GnRH agonist protocol. Fewer oocytes were retrieved for the GnRH antagonist protocol than the long GnRH agonist protocol (MD, -0.34; 95% CI, -0.54 to -0.13) or the short GnRH agonist protocol (MD, -0.54; 95% CI, -0.9, 8 to -0.10). The cycle cancellation and clinical pregnancy rates were not statistically significantly different between the two groups. CONCLUSION(S) Compared with GnRH agonist protocols, the GnRH antagonist protocol is associated with fewer oocytes retrieved, lower E2 levels, and thinner endometrium whereas the clinical pregnancy and cycle cancellation rates are similar.
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Affiliation(s)
- Jinsong Xiao
- Reproductive Medicine Center, Taihe Hospital, Hubei University of Medicine, Shiyan City, People's Republic of China.
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19
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Weissman A, Ravhon A, Steinfeld Z, Nahum H, Golan A, Levran D. Controlled ovarian stimulation using a long gonadotropin-releasing hormone antagonist protocol: a proof of concept and feasibility study. Gynecol Obstet Invest 2013; 76:113-8. [PMID: 23920048 DOI: 10.1159/000351570] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 04/23/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS To evaluate the feasibility of a long protocol of controlled ovarian stimulation prior to in vitro fertilization (IVF) and embryo transfer with a gonadotropin-releasing hormone (GnRH) antagonist used for pituitary and ovarian suppression. METHODS Thirty patients undergoing IVF/intracytoplasmic sperm injection were randomized into two groups. The control group (n = 16) received a standard flexible GnRH antagonist protocol. Ovarian stimulation consisted of 225 IU/day of recombinant follicle-stimulating hormone for 5 days, followed by 225 IU/day of human menopausal gonadotropin until human chorionic gonadotropin (hCG) administration. The study group (n = 14) received 0.25 mg of GnRH antagonist daily for 7 days, thereafter, upon confirmation of pituitary and ovarian suppression, ovarian stimulation was commenced with the same protocol as used in the control group. Hormone and follicle dynamics, as well as laboratory characteristics and cycle outcome, were compared for both groups. RESULTS Both groups were comparable in baseline characteristics. Pituitary and ovarian suppression were effectively achieved in 12/14 patients in the study group. The duration of ovarian stimulation and gonadotropin consumption were similar in both groups, as was also the number and size of follicles on hCG day. CONCLUSION The results of our study confirm the feasibility of a long GnRH antagonist protocol. This regimen could become another option to optimize GnRH antagonist protocols, and should thus be further explored.
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Affiliation(s)
- Ariel Weissman
- IVF Unit, Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Chang HJ, Lee JR, Jee BC, Suh CS, Lee WD, Kim SH. Cessation of gonadotropin-releasing hormone antagonist on triggering day in flexible multiple-dose protocol: A randomized controlled study. Clin Exp Reprod Med 2013; 40:83-9. [PMID: 23875164 PMCID: PMC3714433 DOI: 10.5653/cerm.2013.40.2.83] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 05/05/2013] [Accepted: 05/15/2013] [Indexed: 11/30/2022] Open
Abstract
Objective To investigate outcomes of stimulated IVF cycles in which GnRH antagonist was omitted on the ovulation triggering day. Methods A total of 86 women who underwent controlled ovarian hyperstimulation with recombinant FSH and GnRH antagonist flexible multiple-dose protocols were recruited and prospectively randomized into the conventional group (group A) or cessation group (group B). The GnRH antagonist, 0.25 mg/day of cetrorelix, was started when the leading follicle reached 14 mm in diameter and was continuously administered until the hCG triggering day (group A, 43 cycles) or until the day before hCG administration (group B, 43 cycles). The maturity of oocytes, fertilization rate, embryo quality, and implantation and clinical pregnancy rates were evaluated. Results The duration of ovarian stimulation, total dose of gonadotropins, serum estradiol levels on hCG administration day, and number of oocytes retrieved were not significantly different between the two groups. The total dose of GnRH antagonist was significantly lower in group B than group A (2.5±0.9 vs. 3.2±0.8 ampoules, p<0.05). There was no premature luteinization in any of the subjects. The proportion of mature oocytes and fertilization rate were not significantly different in group B than group A (70.7% vs. 66.7%; 71.1% vs. 66.4%, respectively). There were no significant differences in the implantation or clinical pregnancy rates. Conclusion Our prospective randomized study suggested that cessation of GnRH antagonist on the hCG administration day during a flexible multiple-dose protocol could reduce the total dose of GnRH antagonist without compromising its effects on pregnancy rates.
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Affiliation(s)
- Hye Jin Chang
- Health Promotion Center, Seoul National University Bundang Hospital, Seongnam, Korea
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21
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van der Gaast MH, Beckers NGM, Beier-Hellwig K, Beier HM, Macklon NS, Fauser BCJM. Ovarian stimulation for IVF and endometrial receptivity--the missing link. Reprod Biomed Online 2013; 5 Suppl 1:36-43. [PMID: 12537780 DOI: 10.1016/s1472-6483(11)60215-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
The contemporary approach to ovarian stimulation for IVF treatment results in supraphysiological concentrations of steroids during the follicular and luteal phases of the menstrual cycle. These sex steroids act directly and indirectly to mature the endometrium, influencing receptivity for implantation. Corpus luteum function is distinctly abnormal in IVF cycles, and therefore luteal support is widely used. Various reasons may underlie the defective luteal phase, including (i) ovarian hyperstimulation per se, (ii) gonadotrophin-releasing hormone (GnRH) analogue co-treatment and (iii) the use of human chorionic gonadotrophin (HCG) to induce final oocyte maturation. The recent introduction of GnRH antagonist co-treatment for the prevention of a premature LH rise during the late follicular phase allows for different approaches to ovarian stimulation for IVF. However, a recent meta-analysis showed that implantation rates may be compromised by using GnRH antagonists in currently employed regimens. The development of endometrium receptive to embryo implantation is a complex process and may be altered by inappropriate exposure to sex steroids in terms of timing, duration and magnitude. New approaches to the assessment of endometrial receptivity are now required. Novel approaches to ovarian stimulation aimed at adjusted GnRH antagonist regimens and achieving a more physiological luteal phase endocrinology are now appearing in the literature and may represent an important step in the improvement of the overall health economics of IVF.
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Affiliation(s)
- M H van der Gaast
- Division of Reproductive Medicine, Department of Obstetrics and Gynaecology, Erasmus Medical Centre, Rotterdam, The Netherlands
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Asimakopoulos B, Nikolettos N, Al-Hasani S. Outcome of cryopreserved pronuclear oocytes obtained after ovarian stimulation with either HMG or recFSH and the GnRH-antagonist cetrorelix. Reprod Biomed Online 2013; 5 Suppl 1:52-6. [PMID: 12537782 DOI: 10.1016/s1472-6483(11)60217-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The present retrospective study evaluated the outcome of frozen-thaw cycles with oocytes obtained either during a multiple dose protocol of cetrorelix, or after the use of a gonadotrophin-releasing hormone (GnRH) agonist. A total of 101 subfertile couples were included. These couples had a total of 222 transfers of frozen-thawed pronuclear oocytes after IVF/intracytoplasmic sperm injection (ICSI) treatment. According to the stimulation protocol during various cycles, four groups were established: cetrorelix/recombinant FSH (recFSH) (69 cycles), cetrorelix/human menopausal gonadotrophin (HMG) (10 cycles), GnRH-agonist/recFSH (71 cycles) and GnRH-agonist/HMG (72 cycles). The transfer cycles were mildly stimulated with transdermal oestradiol. No statistically significant difference was seen among the four groups regarding post-thaw survival rate, cumulative embryo score, implantation rate and pregnancies. Frozen-thawed pronuclear oocytes obtained with the use of cetrorelix give satisfactory implantation and pregnancy rates, similar to those obtained with a GnRH-agonist. These results do not depend on the gonadotrophins (HMG or recFSH) used in the collecting cycle.
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Affiliation(s)
- Byron Asimakopoulos
- Laboratory of Reproductive Physiology, Faculty of Medicine, Demokritus University of Thrace, Dragana, 68100 Alexandroupolis, Greece
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Barri PN, Martinez F, Coroleu B, Tur R. The role of GnRH antagonists in assisted reproduction. Reprod Biomed Online 2013; 5 Suppl 1:14-9. [PMID: 12537777 DOI: 10.1016/s1472-6483(11)60212-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The different schemes of application of gonadotrophin-releasing hormone (GnRH) antagonists in ovarian stimulation protocols for assisted reproduction are reviewed. Starting from the initial schemes of single and/or multiple doses, the efficacy of GnRH antagonists in 'soft' protocols of ovarian stimulation has been evaluated in natural cycles, and the possibility of inducing the final oocyte maturation under antagonists either with native luteinizing hormone-releasing hormone or with GnRH agonists. The largest clinical studies carried out with cetrorelix or with ganirelix and published to date were analysed. Apart from the benefits of reducing the duration of the treatment, gonadotrophin requirements and ovarian hyperstimulation syndrome incidence, there is still a serious debate on the potential deleterious effect of GnRH antagonists on implantation and pregnancy rates. More specific aspects such as cycle programming, application of GnRH antagonists in protocols for poor responders etc., were also reviewed in this survey.
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Affiliation(s)
- Pedro N Barri
- Service of Reproductive Medicine, Department of Obstetrics and Gynecology, Institut Universitari Dexeus, Paseo Bonanova 67, 08017 Barcelona, Spain.
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Maldonado LGL, Franco JG, Setti AS, Iaconelli A, Borges E. Cost-effectiveness comparison between pituitary down-regulation with a gonadotropin-releasing hormone agonist short regimen on alternate days and an antagonist protocol for assisted fertilization treatments. Fertil Steril 2013; 99:1615-22. [DOI: 10.1016/j.fertnstert.2013.01.095] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Revised: 01/07/2013] [Accepted: 01/09/2013] [Indexed: 11/30/2022]
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Effect of a low dose of gonadotropin releasing hormone antagonist on in vitro fertilization outcomes. Arch Gynecol Obstet 2013; 288:691-5. [PMID: 23525593 DOI: 10.1007/s00404-013-2806-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Accepted: 03/12/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE This study aims to determine whether a low dose of the gonadotropin releasing hormone antagonist, cetrorelix, prevents a premature luteinizing hormone (LH) surge and affects in vitro fertilization (IVF) outcomes compared to the standard dose of 0.25 mg/day. METHODS In this study, 45 IVF/intracytoplasmic sperm injection patients were stimulated with recombinant follicle stimulation hormone from day 2 of the cycle. Cetrorelix was injected daily from day 6 of gonadotropin administration. Twenty-two patients received cetrorelix at a dose of 0.25 mg/day, whereas 23 participants received half dose. RESULTS The mean consumption of gonadotropins was significantly higher in patients receiving 0.25 mg/day of cetrorelix (2,213 vs. 1,350 U; p = 0.046). The clinical pregnancy rates were similar in both groups (31.8 vs. 47.8 %; p = 0.273). Premature LH surge was detected in 9.1 % of the patients receiving cetrorelix 0.25 mg/day and in 13 % of the patients receiving cetrorelix 0.125 mg/day (p > 0.05). The difference between two groups was not statistically significant (p > 0.05). CONCLUSIONS Our results suggest that there is no difference between a cetrorelix dose of 0.125 or 0.25 mg/day in preventing premature LH rise during ovarian stimulation for IVF.
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Hosseini MA, Mahdavi A, Aleyasin A, Safdarian L, Bahmaee F. Treatment of ovarian hyperstimulation syndrome using gonadotropin releasing hormone antagonist: a pilot study. Gynecol Endocrinol 2012; 28:853-5. [PMID: 22697477 DOI: 10.3109/09513590.2012.683076] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE This novel study describes an effective outpatient treatment for ovarian hyperstimulation syndrome (OHSS) that results in rapid normalization of symptoms. STUDY DESIGN A total of twenty-seven infertile women undergoing assisted reproductive technique with early-onset OHSS were enrolled in this non-randomized clinical trial in an academic infertility center. In all patients, after complete desensitization with long-term protocol ovarian stimulation with gonadotropins was commenced. Final oocyte maturation was triggered with human chorionic gonadotrophin. Oocytes were collected 36-38 h later using transvaginal-guided follicle aspiration under general anaesthesia. All embryos were frozen and study group patients received two consecutive doses of GnRH antagonist (Cetrotide) and the control group received daily dose of cabergoline for a week. RESULTS The research revealed that moderate and severe OHSS, hospitalization or acute care for OHSS and ascites tap were significantly lower in the antagonist (Cetrotide) group. The Patients' satisfaction with Cetrotide was noticeable. No side effect was reported in either group. CONCLUSION GnRH antagonists seem to be an effective outpatient treatment with rapid onset activity and minimal side effects for the management of early OHSS.
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Affiliation(s)
- Marzieh Agha Hosseini
- Department of Infertility, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Cota AMM, Oliveira JBA, Petersen CG, Mauri AL, Massaro FC, Silva LFI, Nicoletti A, Cavagna M, Baruffi RLR, Franco JG. GnRH agonist versus GnRH antagonist in assisted reproduction cycles: oocyte morphology. Reprod Biol Endocrinol 2012; 10:33. [PMID: 22540993 PMCID: PMC3464873 DOI: 10.1186/1477-7827-10-33] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Accepted: 04/27/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The selection of developmentally competent human gametes may increase the efficiency of assisted reproduction. Spermatozoa and oocytes are usually assessed according to morphological criteria. Oocyte morphology can be affected by the age, genetic characteristics, and factors related to controlled ovarian stimulation. However, there is a lack of evidence in the literature concerning the effect of gonadotropin-releasing hormone (GnRH) analogues, either agonists or antagonists, on oocyte morphology. The aim of this randomized study was to investigate whether the prevalence of oocyte dysmorphism is influenced by the type of pituitary suppression used in ovarian stimulation. METHODS A total of 64 patients in the first intracytoplasmic sperm injection (ICSI) cycle were prospectively randomized to receive treatment with either a GnRH agonist with a long-term protocol (n: 32) or a GnRH antagonist with a multi-dose protocol (n: 32). Before being subjected to ICSI, the oocytes at metaphase II from both groups were morphologically analyzed under an inverted light microscope at 400x magnification. The oocytes were classified as follows: normal or with cytoplasmic dysmorphism, extracytoplasmic dysmorphism, or both. The number of dysmorphic oocytes per total number of oocytes was analyzed. RESULTS Out of a total of 681 oocytes, 189 (27.8%) were morphologically normal, 220 (32.3%) showed cytoplasmic dysmorphism, 124 (18.2%) showed extracytoplasmic alterations, and 148 (21.7%) exhibited both types of dysmorphism. No significant difference in oocyte dysmorphism was observed between the agonist- and antagonist-treated groups (P>0.05). Analysis for each dysmorphism revealed that the most common conditions were alterations in polar body shape (31.3%) and the presence of diffuse cytoplasmic granulations (22.8%), refractile bodies (18.5%) and central cytoplasmic granulations (13.6%). There was no significant difference among individual oocyte dysmorphisms in the agonist- and antagonist-treated groups (P>0.05). CONCLUSIONS Our randomized data indicate that in terms of the quality of oocyte morphology, there is no difference between the antagonist multi-dose protocol and the long-term agonist protocol. If a GnRH analogue used for pituitary suppression in IVF cycles influences the prevalence of oocyte dysmorphisms, there does not appear to be a difference between the use of an agonist as opposed to an antagonist.
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Affiliation(s)
- Ana Marcia M Cota
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University—UNESP, Botucatu, Brazil
| | - Joao Batista A Oliveira
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University—UNESP, Botucatu, Brazil
- Center for Human Reproduction Prof. Franco Junior, Ribeirao Preto, Brazil
- Paulista Center for Diagnosis, Research and Training, Ribeirao Preto, Brazil
| | - Claudia G Petersen
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University—UNESP, Botucatu, Brazil
- Center for Human Reproduction Prof. Franco Junior, Ribeirao Preto, Brazil
- Paulista Center for Diagnosis, Research and Training, Ribeirao Preto, Brazil
| | - Ana L Mauri
- Center for Human Reproduction Prof. Franco Junior, Ribeirao Preto, Brazil
- Paulista Center for Diagnosis, Research and Training, Ribeirao Preto, Brazil
| | - Fabiana C Massaro
- Center for Human Reproduction Prof. Franco Junior, Ribeirao Preto, Brazil
- Paulista Center for Diagnosis, Research and Training, Ribeirao Preto, Brazil
| | - Liliane FI Silva
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University—UNESP, Botucatu, Brazil
- Center for Human Reproduction Prof. Franco Junior, Ribeirao Preto, Brazil
- Paulista Center for Diagnosis, Research and Training, Ribeirao Preto, Brazil
| | - Andreia Nicoletti
- Center for Human Reproduction Prof. Franco Junior, Ribeirao Preto, Brazil
| | - Mario Cavagna
- Center for Human Reproduction Prof. Franco Junior, Ribeirao Preto, Brazil
- Paulista Center for Diagnosis, Research and Training, Ribeirao Preto, Brazil
- Women’s Health Reference Center, Perola Byington Hospital, Sao Paulo, Brazil
| | - Ricardo LR Baruffi
- Center for Human Reproduction Prof. Franco Junior, Ribeirao Preto, Brazil
- Paulista Center for Diagnosis, Research and Training, Ribeirao Preto, Brazil
| | - José G Franco
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University—UNESP, Botucatu, Brazil
- Center for Human Reproduction Prof. Franco Junior, Ribeirao Preto, Brazil
- Paulista Center for Diagnosis, Research and Training, Ribeirao Preto, Brazil
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Wu HM, Wang HS, Soong YK, Huang HY, Chen CK, Lee CL, Leung PCK. Gonadotrophin-releasing hormone antagonist induces apoptosis in human decidual stromal cells: effect on GADD45 and MAPK signaling. Hum Reprod 2012; 27:795-804. [DOI: 10.1093/humrep/der460] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Martínez F, Latre L, Clua E, Rodriguez I, Coroleu B. Replacing GnRH agonists with GnRH antagonists in oocyte recipient cycle did not adversely affect the pregnancy rates. Eur J Obstet Gynecol Reprod Biol 2011; 159:355-8. [DOI: 10.1016/j.ejogrb.2011.06.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Revised: 05/10/2011] [Accepted: 06/09/2011] [Indexed: 11/25/2022]
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Cavagna M, Paes de Almeida Ferreira Braga D, Biaggioni Lopes F, de Cássia Savio Figueira R, Iaconelli A, Borges E. The effect of GnRH analogues for pituitary suppression on ovarian response in repeated ovarian stimulation cycles. Arch Med Sci 2011; 7:470-5. [PMID: 22295031 PMCID: PMC3258761 DOI: 10.5114/aoms.2011.23414] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2010] [Revised: 04/10/2010] [Accepted: 05/20/2010] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Ovarian stimulation is employed in assisted reproduction techniques in order to obtain as many oocytes as possible. The early rise in oestradiol levels may lead to the premature end of the respective cycle. In order to avoid such an effect, pituitary suppression has been employed. The aim of this study was to evaluate whether maintenance or replacement of the type of GnRH analogue (i.e., agonist or antagonist) employed for pituitary suppression in the consecutive intracytoplasmic sperm injection (ICSI) cycle would negatively influence oocyte quality and ICSI outcome. MATERIAL AND METHODS A retrospective observational study was conducted including 181 women with primary infertility. Patients were divided into four different groups according to the GnRH analogue used for pituitary suppression in the first and consecutive cycle. RESULTS When a GnRH agonist was employed for pituitary suppression in the first cycle, the consecutive cycle showed comparable outcomes when performed with either a GnRH agonist or a GnRH antagonist. When the first cycle was performed with a GnRH antagonist, the use of the GnRH agonist in the successive cycle led to an increased number of oocytes retrieved (7.5% vs. 10.3%, p = 0.032) and the production of a higher number of embryos (4.5% vs. 6.3%, p = 0.036). CONCLUSIONS When the first cycle is carried out with a GnRH antagonist, the use of a GnRH agonist in the successive cycle would lead to increased numbers of oocytes collected and embryos produced.
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Affiliation(s)
- Mario Cavagna
- Women’s Health Reference Center, Hospital Perola Byington, São Paulo, Brazil
| | - Daniela Paes de Almeida Ferreira Braga
- Fertility-Assisted Fertilization Center, São Paulo, Brazil
- Sapientiae Institute – Educational and Research Center in Assisted Reproduction, São Paulo, Brazil
| | | | | | | | - Edson Borges
- Fertility-Assisted Fertilization Center, São Paulo, Brazil
- Sapientiae Institute – Educational and Research Center in Assisted Reproduction, São Paulo, Brazil
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Garcia-Velasco JA, Bennink HJTC, Epifanio R, Escudero E, Pellicer A, Simón C. High-dose recombinant LH add-back strategy using high-dose GnRH antagonist is an innovative protocol compared with standard GnRH antagonist. Reprod Biomed Online 2011; 22 Suppl 1:S52-9. [DOI: 10.1016/s1472-6483(11)60009-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2006] [Revised: 09/20/2006] [Accepted: 06/20/2007] [Indexed: 10/18/2022]
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Chou LL, Hwu YM, Lin MH, Lin SY, Lee RKK. Outcomes of High Initial Daily Doses of Gonadotropin in Patients With Poor Ovarian Reserve. Taiwan J Obstet Gynecol 2010; 49:442-8. [DOI: 10.1016/s1028-4559(10)60096-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2010] [Indexed: 11/27/2022] Open
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Kinay T, Tasci Y, Dilbaz S, Cinar O, Demir B, Haberal A. The relationship between endometrial thickness and pregnancy rates in GnRH antagonist down-regulated ICSI cycles. Gynecol Endocrinol 2010; 26:833-7. [PMID: 20504095 DOI: 10.3109/09513590.2010.487591] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To investigate the effects of endometrial thickness measurements and serum hormone levels on the outcomes of GnRH antagonist down-regulated ICSI cycles. STUDY DESIGN Forty consecutive infertile women undergoing controlled ovarian hyperstimulation with recombinant FSH and GnRH antagonists for ICSI were enrolled in this study. All patient's age, day 3 FSH, antral follicle count (AFC), serum E2 levels on day 3, E2 on stimulation day 5, E2 on day of hCG administration, endometrial thickness on the baseline (ETMBaseline), on day 5 of stimulation (ETMDay 5), on day of hCG administration (ETMhCG) and cycle outcomes were recorded. The outcomes of pregnant and nonpregnant women were compared. RESULTS Women's age was 33.6 +/- 4.9. Overall pregnancy rate was 45% (n = 18), clinical pregnancy rate was 27.5% (n = 11) and ongoing pregnancy rate was 20% (n = 8). In pregnant women, baseline AFC was significantly higher compared with nonpregnant women (p = 0.01). There was no significant correlation between ETMhCG and E2 level on the day of hCG, number of retrieved oocytes or patients' age. CONCLUSION For achieving pregnancy, endometrial thickness on the day of hCG is not a determining parameter, and the only significant determinent is AFC in GnRH antagonist down-regulated ICSI cycles.
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Affiliation(s)
- Tugba Kinay
- Ministry of Health, Etlik Zubeyde Hanim Women's Health Research Hospital, Obstetrics and Gynecology, Ankara, Turkey
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Cavagna M, Maldonado LGL, de Souza Bonetti TC, de Almeida Ferreira Braga DP, Iaconelli Jr. A, Borges Jr. E. Supplementation with a recombinant human chorionic gonadotropin microdose leads to similar outcomes in ovarian stimulation with recombinant follicle-stimulating hormone using either a gonadotropin-releasing hormone agonist or antagonist for pituitary suppression. Fertil Steril 2010; 94:167-72. [DOI: 10.1016/j.fertnstert.2009.02.075] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2008] [Revised: 02/16/2009] [Accepted: 02/25/2009] [Indexed: 10/21/2022]
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Imai A, Furui T. Chemotherapy-induced female infertility and protective action of gonadotropin-releasing hormone analogues. J OBSTET GYNAECOL 2009; 27:20-4. [PMID: 17365452 DOI: 10.1080/01443610601056467] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This review aimed to critically discuss the current protocols using gonadotropin-releasing hormone analogue (GnRHa) for the management of chemotherapy-induced premature ovarian failure. In in-vitro experiments, GnRHa retards doxorubicin-induced granulosa cell damage, suggesting an additional GnRH's activity to protect the gonads during chemotherapy through GnRH receptor-mediated mechanism(s). GnRHa acts to protect the gonads during radiation and/or chemotherapy by preferentially steering cells into cell cycle arrest with a decline in response to the chemotherapeutic agents. The ovarian protection by GnRHa co-treatment against chemotherapy can enable the preservation of future fertility in survivors and prevent the bone demineralisation and osteoporosis associated with hypooestrogenism and ovarian failure.
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Affiliation(s)
- A Imai
- Department of Obstetrics and Gynecology, Gifu University School of Medicine, Japan.
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Microdose gonadotropin-releasing hormone agonist flare-up protocol versus multiple dose gonadotropin-releasing hormone antagonist protocol in poor responders undergoing intracytoplasmic sperm injection–embryo transfer cycle. Fertil Steril 2009; 91:2437-44. [DOI: 10.1016/j.fertnstert.2008.03.057] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2007] [Revised: 03/23/2008] [Accepted: 03/24/2008] [Indexed: 11/22/2022]
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Chang HJ, Lee JR, Jee BC, Suh CS, Kim SH. Cessation of gonadotropin-releasing hormone antagonist on triggering day: an alternative method for flexible multiple-dose protocol. J Korean Med Sci 2009; 24:262-8. [PMID: 19399268 PMCID: PMC2672126 DOI: 10.3346/jkms.2009.24.2.262] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2008] [Accepted: 06/26/2008] [Indexed: 12/02/2022] Open
Abstract
This study was performed to analyze retrospectively outcomes of stimulated in vitro fertilization (IVF) cycles where the gonadotropin-releasing hormone (GnRH) antagonist was omitted on ovulation triggering day. A total of 92 consecutive IVF cycles were included in 65 women who are undergoing ovarian stimulation with recombinant FSH. A GnRH antagonist, cetrorelix 0.25 mg/day, was started when leading follicle reached 14 mm in diameter until the day of hCG administration (Group A, 66 cycles) or until the day before hCG administration (Group B, 26 cycles). The duration of ovarian stimulation, total dose of gonadotropins, serum estradiol levels on hCG administration day, and the number of oocytes retrieved were not significantly different between the two groups. The total dose of GnRH antagonist was significantly lower in Group B compared to Group A (2.7+/-0.8 vs. 3.2+/-0.9 ampoules). There was no premature luteinization in the subjects. The proportion of mature oocytes (71.4% vs. 61.7%) and fertilization rate of mature (86.3+/-19.7% vs. 71.8+/-31.7%) was significantly higher in Group B. There were no significant differences in embryo quality and clinical pregnancy rates. Our results suggest that cessation of the GnRH antagonist on the day of hCG administration during a flexible multiple-dose protocol could reduce the total dose of GnRH antagonist without compromising IVF results.
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Affiliation(s)
- Hye Jin Chang
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
- Health Promotion Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jung Ryeol Lee
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Obstetrics and Gynecology, College of Medicine, Seoul National University, Seoul, Korea
| | - Byung Chul Jee
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Chang Suk Suh
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Obstetrics and Gynecology, College of Medicine, Seoul National University, Seoul, Korea
| | - Seok Hyun Kim
- Department of Obstetrics and Gynecology, College of Medicine, Seoul National University, Seoul, Korea
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Pinto F, Oliveira C, Cardoso MF, Teixeira-da-Silva J, Silva J, Sousa M, Barros A. Impact of GnRH ovarian stimulation protocols on intracytoplasmic sperm injection outcomes. Reprod Biol Endocrinol 2009; 7:5. [PMID: 19146685 PMCID: PMC2633006 DOI: 10.1186/1477-7827-7-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2008] [Accepted: 01/15/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although a large number of studies have been conducted in relation to ovarian response and pregnancy after GnRH agonist and GnRH antagonist controlled ovarian hyperstimulation protocols, most of them used single or combinations of a few predictive factors, and none included the stimulation protocol in the multivariable analysis. The present study was thus primarily designed to investigate the predictive value of the stimulation protocol and to analyze the possible relationships between stimulation protocols and treatment outcomes after adjusting for a large set of variables that potentially affect reproductive outcomes. Factors related to pregnancy achievement and predictive of the number of oocytes retrieved and high quality of the embryos obtained were also analyzed. METHODS To analyze the impact of GnRH ovarian stimulation protocols on the independent predictors of ovarian response, high quality embryos and clinical pregnancy, two groups out of 278 ICSI treatment cycles were compared prospectively, 123 with a GnRH agonist and 155 with a GnRH antagonist, with multivariable analysis assessing outcomes after adjusting for a large set of variables. RESULTS Antagonists were significantly associated with lower length and total dose of GnRH, lower length of rFSH, and higher numbers of oocytes and high quality embryos, whereas the agonist presented a higher fertilization rate and probability of pregnancy. Significant predictors of retrieved oocytes and high quality embryos were the antagonist protocol, lower female age, lower serum levels of basal FSH and higher total number of antral follicles. Significant predictors of clinical pregnancy were the agonist protocol, reduced number of attempts, increased endometrial thickness and lower female age. The probability of pregnancy increased until 30 years-old, with a decline after that age and with a sharp decline after 40 years-old. CONCLUSION The models found suggest that not only the protocol but also factors as female age, basal FSH, antral follicles, number of attempts and endometrial thickness should be analyzed for counselling patients undergoing an ICSI treatment.
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Affiliation(s)
- Fátima Pinto
- Faculty of Engineering, University of Porto, Porto, Portugal
| | | | - Margarida F Cardoso
- Department of Population Studies, ICBAS-Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
| | | | - Joaquina Silva
- Centre for Reproductive Genetics A. Barros, Porto, Portugal
| | - Mário Sousa
- Centre for Reproductive Genetics A. Barros, Porto, Portugal
- Lab Cell Biology, ICBAS-Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
- Department of Genetics, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Alberto Barros
- Centre for Reproductive Genetics A. Barros, Porto, Portugal
- Department of Genetics, Faculty of Medicine, University of Porto, Porto, Portugal
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Bahçeci M, Ulug U, Erden HF, Tosun S, çiray N. Frozen–thawed cleavage-stage embryo transfer cycles after previous GnRH agonist or antagonist stimulation. Reprod Biomed Online 2009; 18:67-72. [DOI: 10.1016/s1472-6483(10)60426-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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GnRH antagonists and endometrial receptivity in oocyte recipients: a prospective randomized trial. Reprod Biomed Online 2009; 18:276-81. [DOI: 10.1016/s1472-6483(10)60266-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Demirol A, Gurgan T. Comparison of microdose flare-up and antagonist multiple-dose protocols for poor-responder patients: a randomized study. Fertil Steril 2008; 92:481-5. [PMID: 18990368 DOI: 10.1016/j.fertnstert.2008.07.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2006] [Revised: 06/21/2008] [Accepted: 07/09/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To compare the efficacy of the microdose flare-up and multiple-dose antagonist protocols for poor-responder patients in intracytoplasmic sperm injection-ET cycles. DESIGN A randomized, prospective study. SETTING Center for assisted reproductive technology in Turkey. PATIENT(S) Ninety patients with poor ovarian response in a minimum of two previous IVF cycles. INTERVENTION(S) All women were prospectively randomized into two groups by computer-assisted randomization. The patients in group 1 were stimulated according to the microdose flare-up protocol (n = 45), while the patients in group 2 were stimulated according to antagonist multiple-dose protocol (n = 45). MAIN OUTCOME MEASURE(S) The mean number of mature oocytes retrieved was the primary outcome measure, and fertilization rate, implantation rate per embryo, and clinical pregnancy rates were secondary outcome measures. RESULT(S) The mean age of the women, the mean duration of infertility, basal FSH level, and the number of previous IVF cycles were similar in both groups. The total gonadotropin dose used was significantly higher in group 2, while the number of oocytes retrieved was significantly greater in group 1. Although the fertilization and clinical pregnancy rates were nonsignificantly higher in group 1 compared with group 2, the implantation rate was significantly higher in the microdose flare-up group than in the multiple-dose antagonist group (22% vs. 11%). CONCLUSION(S) The microdose flare-up protocol seems to have a better outcome in poor-responder patients, with a significantly higher mean number of mature oocytes retrieved and higher implantation rate.
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Affiliation(s)
- Aygul Demirol
- Clinic Women Health, Infertility and IVF Center, Hacettepe University Faculty of Medicine, Ankara, Turkey.
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Detti L, Yelian FD, Kruger ML, Diamond MP, Puscheck EE. Endometrial thickness dynamics and morphologic characteristics during pituitary downregulation with antagonists in assisted reproductive technology cycles. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2008; 27:1591-1596. [PMID: 18946098 DOI: 10.7863/jum.2008.27.11.1591] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate whether the dynamics of endometrial stripe thickness during gonadotropin-releasing hormone (GnRH) antagonist pituitary downregulation in in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) cycles are related to implantation and pregnancy outcomes. METHODS This retrospective cohort study evaluated 115 conventional IVF/ICSI cycles. All patients underwent ovarian stimulation with gonadotropins and the GnRH antagonist ganirelix acetate. The endometrial stripe was measured transvaginally daily from the day of initial GnRH antagonist administration to the day of the human chorionic gonadotropin (hCG) trigger and then transabdominally on the day of embryo transfer. We created 5 categories (0-4) of endometrial thickness variation, considering significant a daily variation of 1.5 mm. Our aim was to predict whether the endometrial thickness dynamics or morphologic characteristics were related to the duration of ovarian stimulation, duration of ganirelix use, or estradiol levels during ovarian stimulation and whether they would influence implantation and pregnancy rates. RESULTS No relationship was found between the duration of ovarian stimulation, duration of ganirelix use, and estradiol level (expressed as the area under the curve), and endometrial thickness dynamics or morphologic characteristics. Despite a thinner endometrial thickness in 37% of the cycles on the day of the hCG trigger compared with the beginning of GnRH antagonist stimulation, there was no correlation between endometrial dynamics and pregnancy outcomes. There was, instead, a positive relationship between a trilaminar endometrial morphologic pattern with a positive pregnancy test result, successful implantation, and ongoing pregnancy (P < .05). CONCLUSIONS Despite a net decrease in thickness in almost 50% of cases, endometrial dynamics did not correlate with pregnancy outcomes. Conversely, a trilaminar endometrial morphologic pattern on the day of embryo transfer was positively related to pregnancy outcomes.
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Affiliation(s)
- Laura Detti
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Wayne State University School of Medicine, Detroit, MI 48201 USA.
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Orvieto R, Meltzer S, Rabinson J, Zohav E, Anteby EY, Nahum R. GnRH agonist versus GnRH antagonist in ovarian stimulation: the role of endometrial receptivity. Fertil Steril 2008; 90:1294-6. [DOI: 10.1016/j.fertnstert.2007.10.022] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2007] [Revised: 10/08/2007] [Accepted: 10/08/2007] [Indexed: 10/22/2022]
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Schachter M, Friedler S, Ron-El R, Zimmerman AL, Strassburger D, Bern O, Raziel A. Can pregnancy rate be improved in gonadotropin-releasing hormone (GnRH) antagonist cycles by administering GnRH agonist before oocyte retrieval? A prospective, randomized study. Fertil Steril 2008; 90:1087-93. [DOI: 10.1016/j.fertnstert.2007.07.1316] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2006] [Revised: 07/07/2007] [Accepted: 07/16/2007] [Indexed: 11/26/2022]
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Detti L, Ambler DR, Yelian FD, Kruger ML, Diamond MP, Puscheck EE. Timing and duration of use of GnRH antagonist down-regulation for IVF/ICSI cycles have no impact on oocyte quality or pregnancy outcomes. J Assist Reprod Genet 2008; 25:177-81. [PMID: 18461435 DOI: 10.1007/s10815-008-9217-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2008] [Accepted: 03/24/2008] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To evaluate whether oocyte quality, implantation and pregnancy outcomes in in vitro fertilization (IVF)/intra-cytoplasmic sperm injection (ICSI) are related to the duration of gonadotropin-releasing hormone (GnRH)-antagonist use or the timing of its initiation. METHODS Retrospective cohort study of 178 conventional IVF/ICSI cycles. All patients underwent ovarian stimulation with gonadotropins and GnRH-antagonist for pituitary down-regulation. Spearman correlations and logistic regression were used for statistical analysis. RESULTS There was no correlation between the duration of use or the timing of initiation of GnRH-antagonist with oocyte quality or implantation and pregnancy outcomes. Oocyte quality was influenced by the peak estradiol. Implantation was influenced by the patient's age. Early pregnancy loss, by the endometrial thickness on human chorionic gonadotropin-day. Ongoing pregnancy was independent from the variables evaluated. CONCLUSIONS GnRH-antagonist duration of use or starting day did not influence oocyte quality, implantation rates, and pregnancy rates. We hypothesize that a follicle stimulating hormone/luteinizing hormone dose increase when antagonist was started, may have had an impact on our findings.
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Affiliation(s)
- Laura Detti
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Wayne State University School of Medicine, 3750 Woodward Ave., Suite 200-D, Detroit, MI, 48201, USA.
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Rackow BW, Kliman HJ, Taylor HS. GnRH antagonists may affect endometrial receptivity. Fertil Steril 2008; 89:1234-1239. [PMID: 18410932 PMCID: PMC2699407 DOI: 10.1016/j.fertnstert.2007.04.060] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2007] [Revised: 04/23/2007] [Accepted: 04/23/2007] [Indexed: 01/10/2023]
Abstract
OBJECTIVE HOXA10 is an essential regulator of endometrial receptivity. To determine the effect of GnRH antagonists on endometrial receptivity, we assessed endometrial HOXA10 expression in GnRH antagonist, GnRH agonist, and natural cycles. DESIGN Prospective case-control study. SETTING University academic medical center. PATIENT(S) Nineteen subjects were included: 12 subjects underwent controlled ovarian hyperstimulation with recombinant FSH and used either a GnRH antagonist or a GnRH agonist; seven control subjects underwent natural cycles. INTERVENTION(S) Pipelle endometrial biopsies were obtained 11 days after hCG administration or spontaneous LH surge in untreated cycles, respectively. Immunohistochemistry was used to assess HOXA10 protein expression in endometrial glands and stroma. MAIN OUTCOME MEASURE(S) Endometrial HOXA10 protein expression. RESULT(S) HOXA10 expression was significantly decreased in endometrial stromal cells in GnRH antagonist-treated cycles compared with GnRH agonist-treated cycles or natural cycle control subjects. There was no significant difference in glandular cell HOXA10 expression among the three groups. CONCLUSION(S) Use of GnRH antagonists may be associated with impaired HOXA10 expression in endometrial stromal cells and thus may affect endometrial receptivity.
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Affiliation(s)
- Beth W Rackow
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticutt
| | - Harvey J Kliman
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticutt
| | - Hugh S Taylor
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticutt.
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Detti L, Yelian FD, Kruger ML, Diamond MP, Rode A, Mitwally MFM, Puscheck EE. Endometrial thickness is related to miscarriage rate, but not to the estradiol concentration, in cycles down-regulated with gonadotropin-releasing hormone antagonist. Fertil Steril 2008; 89:998-1001. [PMID: 17678904 DOI: 10.1016/j.fertnstert.2007.04.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2006] [Revised: 04/05/2007] [Accepted: 04/05/2007] [Indexed: 10/23/2022]
Abstract
In this retrospective cohort study of 102 ovarian stimulation cycles for IVF/intracytoplasmic sperm injection using GnRH antagonist and gonadotropins, we sought to assess the effect of high E(2) levels on endometrial stripe thickness and its association with pregnancy outcomes and serum E(2) levels. We found no significant correlation between serum E(2) levels (both peak and area under the curve E(2) concentration) and the endometrial thickness. However, there was a statistically significant inverse relationship with early pregnancy loss (31%) if the endometrial thickness was <9.8 mm (sensitivity 71%; specificity 76%).
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Affiliation(s)
- Laura Detti
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Wayne State University School of Medicine, Detroit, Michigan 48201, USA.
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Lee JR, Kim SH, Kim SM, Jee BC, Ku SY, Suh CS, Choi YM, Kim JG, Moon SY. Follicular fluid anti-Müllerian hormone and inhibin B concentrations: comparison between gonadotropin-releasing hormone (GnRH) agonist and GnRH antagonist cycles. Fertil Steril 2008; 89:860-7. [DOI: 10.1016/j.fertnstert.2007.04.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2007] [Revised: 04/10/2007] [Accepted: 04/10/2007] [Indexed: 11/25/2022]
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Abstract
Improvements in the success of cancer treatments have resulted in increased awareness of the long-term effects of treatment, of which gonadal failure is the most significant. Thus, preservation of fertility potential has become a major goal and could be realized by preventing ovarian toxicity or by cryopreservation of reproductive cells/tissues. This review aimed to critically discuss the current protocols for the management of chemotherapy-inducced/radiotherapy-induced premature ovarian failure (POF). A medical approach using the gonadotropin-releasing hormone analog (GnRHa) may act to protect the gonads during radiation and/or chemotherapy by preferentially steering cells into cell cycle arrest with a decline in responsibility to the chemotherapeutic agents. Ovarian protection by GnRHa cotreatment against chemotherapy can enable the preservation of future fertility in survivors and prevent the bone demineralization and osteoporosis associated with hypestrogenism and POF. In vitro fertilization of retrieved oocytes could enable embryo freezing in some patients. Embryo cryopreservation is considered standard practice and widely available, but may seldom be used because of a lack of a male partner, the need to postpone cancer therapy for a few weeks and the possibility that an estrogen rise may be undesirable in sensitive cancer patients. Improvement in oocyte cryopreservation may offer additional possibilities; the prolonged culture of primordial and primary follicles in vitro is still unfeasible. Currently, the cryopreservation of ovarian cortex, which hosts thousands of immature follicles, is an investigational method, but has the advantage of requiring neither a sperm donor nor ovarian stimulation. Fertility preservation is often possible in women undergoing cancer treatment. To preserve the full range of options, fertility preservation procedures should be considered as early as possible during therapy planning. (Reprod Med Biol 2008; 7: 17-27).
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Affiliation(s)
- Atsushi Imai
- Department of Obstetrics and Gynecology, Gifu University School of Medicine, Gifu, Japan
| | - Tatsuro Furui
- Department of Obstetrics and Gynecology, Gifu University School of Medicine, Gifu, Japan
| | - Akio Yamamoto
- Department of Obstetrics and Gynecology, Gifu University School of Medicine, Gifu, Japan
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