1
|
Does Serum LH Level Influence IVF Outcomes in Women with PCOS Undergoing GnRH-Antagonist Stimulation: A Novel Indicator. J Clin Med 2022; 11:jcm11164670. [PMID: 36012922 PMCID: PMC9410231 DOI: 10.3390/jcm11164670] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 08/01/2022] [Accepted: 08/04/2022] [Indexed: 11/20/2022] Open
Abstract
Objective: To explore the influence of LH levels on the IVF/ICSI outcomes in women with PCOSundergoing GnRH-antagonist stimulation protocol. Methods: A total of 142 IVF/ICSI patients in which the females were diagnosed with PCOS and underwent GnRH-antagonist protocol for ovarian stimulation were enrolled. Patients were divided into three groups based on basal LH (bLH) level, LH level on trigger day (hLH), and the ratio of hLH/bLH. The LH levels detected on different days in the stimulation cycle as well as their relationships with the IVF/ICSI outcomes were investigated. The main outcomes we observed were the number of oocytes retrieved, the cumulative chemical pregnancy rate, clinical pregnancy rate, and live birth rate. Other factors included the number of normally fertilized oocytes (2PN), top-quality embryo rate, and total Gn dose. Results: There was no significant difference in the included outcomes and baseline characteristics among different groups based on bLH levels. When patients were grouped according to hLH levels (≤2 mIU/mL, 2–5 mIU/mL and ≥5 mIU/mL), we found decreased levels of basal FSH and LH in the group of hLH ≤ 2 mIU/mL than the other two groups. Then the ratio of hLH/bLH was calculated for each patient. Patients with hLH/bLH ≥ 1 had a higher top-quality embryo rate than those with hLH/bLH between 0.5 and 1.0. Nevertheless, the cumulative clinical pregnancy rate was significantly higher in the hLH/bLH ≤ 0.5 group than in the other two groups. Conclusions: The study proposed the hLH/bLH ratio as a potential in predicting the influence of LH level on the embryo development potential as well as pregnancy outcomes in women with PCOS undergoing GnRH-antagonist stimulation cycles.
Collapse
|
2
|
Treatment of primary infertility in McCune-Albright syndrome: a case report of a successful in vitro fertilization cycle. F S Rep 2021; 2:352-356. [PMID: 34553163 PMCID: PMC8441555 DOI: 10.1016/j.xfre.2021.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 05/13/2021] [Accepted: 05/14/2021] [Indexed: 11/22/2022] Open
Abstract
Objective To report a case in which pregnancy and live birth were achieved in an infertile patient with McCune-Albright syndrome via in vitro fertilization (IVF). Design Case report. Setting University hospital. Patient(s) A 29-year-old woman with McCune-Albright syndrome who presented with primary infertility due to ovulatory dysfunction and bilateral tubal blockage. Intervention(s) In vitro fertilization without unilateral oophorectomy. Main Outcome Measure(s) Live birth after IVF treatment. Result(s) Fresh IVF stimulation and bilateral oocyte retrieval yielded 12 oocytes and 4 top quality embryos. Fresh single embryo transfer did not result in pregnancy. Live birth occurred after the second frozen embryo transfer cycle. Conclusion(s) In vitro fertilization can lead to ongoing pregnancy in infertile patients with McCune-Albright syndrome without requiring unilateral oophorectomy.
Collapse
|
3
|
Behery MA, Hasan EA, Ali EA, Eltabakh AA. Comparative study between agonist and antagonist protocols in PCOS patients undergoing ICSI: a cross-sectional study. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2019. [DOI: 10.1186/s43043-019-0002-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
4
|
Simopoulou M, Sfakianoudis K, Antoniou N, Maziotis E, Rapani A, Bakas P, Anifandis G, Kalampokas T, Bolaris S, Pantou A, Pantos K, Koutsilieris M. Making IVF more effective through the evolution of prediction models: is prognosis the missing piece of the puzzle? Syst Biol Reprod Med 2018; 64:305-323. [PMID: 30088950 DOI: 10.1080/19396368.2018.1504347] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Assisted reproductive technology has evolved tremendously since the emergence of in vitro fertilization (IVF). In the course of the recent decade, there have been significant efforts in order to minimize multiple gestations, while improving percentages of singleton pregnancies and offering individualized services in IVF, in line with the trend of personalized medicine. Patients as well as clinicians and the entire IVF team benefit majorly from 'knowing what to expect' from an IVF cycle. Hereby, the question that has emerged is to what extent prognosis could facilitate toward the achievement of the above goal. In the current review, we present prediction models based on patients' characteristics and IVF data, as well as models based on embryo morphology and biomarkers during culture shaping a complication free and cost-effective personalized treatment. The starting point for the implementation of prediction models was initiated by the aspiration of moving toward optimal practice. Thus, prediction models could serve as useful tools that could safely set the expectations involved during this journey guiding and making IVF treatment more effective. The aim and scope of this review is to thoroughly present the evolution and contribution of prediction models toward an efficient IVF treatment. ABBREVIATIONS IVF: In vitro fertilization; ART: assisted reproduction techniques; BMI: body mass index; OHSS: ovarian hyperstimulation syndrome; eSET: elective single embryo transfer; ESHRE: European Society of Human Reproduction and Embryology; mtDNA: mitochondrial DNA; nDNA: nuclear DNA; ICSI: intracytoplasmic sperm injection; MBR: multiple birth rates; LBR: live birth rates; SART: Society for Assisted Reproductive Technology Clinic Outcome Reporting System; AFC: antral follicle count; GnRH: gonadotrophin releasing hormone; FSH: follicle stimulating hormone; LH: luteinizing hormone; AMH: anti-Müllerian hormone; DHEA: dehydroepiandrosterone; PCOS: polycystic ovarian syndrome; NPCOS: non-polycystic ovarian syndrome; CE: cost-effectiveness; CC: clomiphene citrate; ORT: ovarian reserve test; EU: embryo-uterus; DET: double embryo transfer; CES: Cumulative Embryo Score; GES: Graduated Embryo Score; CSS: Combined Scoring System; MSEQ: Mean Score of Embryo Quality; IMC: integrated morphology cleavage; EFNB2: ephrin-B2; CAMK1D: calcium/calmodulin-dependent protein kinase 1D; GSTA4: glutathione S-transferase alpha 4; GSR: glutathione reductase; PGR: progesterone receptor; AMHR2: anti-Müllerian hormone receptor 2; LIF: leukemia inhibitory factor; sHLA-G: soluble human leukocyte antigen G.
Collapse
Affiliation(s)
- Mara Simopoulou
- a Department of Physiology , Medical School, National and Kapodistrian University of Athens , Athens , Greece.,b Assisted Conception Unit, 2nd Department of Obstetrics and Gynecology , Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens , Athens , Greece
| | | | - Nikolaos Antoniou
- a Department of Physiology , Medical School, National and Kapodistrian University of Athens , Athens , Greece
| | - Evangelos Maziotis
- a Department of Physiology , Medical School, National and Kapodistrian University of Athens , Athens , Greece
| | - Anna Rapani
- a Department of Physiology , Medical School, National and Kapodistrian University of Athens , Athens , Greece
| | - Panagiotis Bakas
- b Assisted Conception Unit, 2nd Department of Obstetrics and Gynecology , Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens , Athens , Greece
| | - George Anifandis
- d Department of Histology and Embryology, Faculty of Medicine , University of Thessaly , Larissa , Greece
| | - Theodoros Kalampokas
- b Assisted Conception Unit, 2nd Department of Obstetrics and Gynecology , Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens , Athens , Greece
| | - Stamatis Bolaris
- e Department fo Obsterics and Gynaecology , Assisted Conception Unit, General-Maternity District Hospital "Elena Venizelou" , Athens , Greece
| | - Agni Pantou
- c Department of Assisted Conception , Human Reproduction Genesis Athens Clinic , Athens , Greece
| | - Konstantinos Pantos
- c Department of Assisted Conception , Human Reproduction Genesis Athens Clinic , Athens , Greece
| | - Michael Koutsilieris
- a Department of Physiology , Medical School, National and Kapodistrian University of Athens , Athens , Greece
| |
Collapse
|
5
|
Jacob SL, Brewer C, Tang T, Picton HM, Barth JH, Balen AH. A short course of metformin does not reduce OHSS in a GnRH antagonist cycle for women with PCOS undergoing IVF: a randomised placebo-controlled trial. Hum Reprod 2016; 31:2756-2764. [PMID: 27816925 DOI: 10.1093/humrep/dew268] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 08/23/2016] [Accepted: 09/17/2016] [Indexed: 11/12/2022] Open
Abstract
STUDY QUESTION Does 'metformin' reduce the incidence of ovarian hyperstimulation syndrome (OHSS) for women with polycystic ovary syndrome (PCOS) undergoing a GnRH antagonist assisted conception treatment cycle? SUMMARY ANSWER A short course of metformin does not reduce the incidence of OHSS for women with PCOS undergoing a GnRH antagonist treatment cycle. WHAT IS KNOWN ALREADY Metformin does reduce the incidence of OHSS in a GnRH-agonist treatment cycle. STUDY DESIGN, SIZE, DURATION A randomised placebo-controlled trial (RCT) using metformin or placebo. Randomisation was blinded to both patient and investigator, using a random permuted blocks method with a 50:50 allocation ratio. The study was completed over 5 years (2009-2014) with 153 randomised patients. A sample size calculation based on the incidence of OHSS was completed prospectively suggesting a minimum of 146 recruits was required for the trial with a power of 80% and a type 1 error of 0.05. PARTICIPANTS/MATERIALS, SETTING, METHODS All patients met the Rotterdam criteria for PCOS and were treated with a standard GnRH antagonist IVF/ICSI treatment cycle in a tertiary infertility clinic. The study medication was started prior to stimulation and continued to oocyte retrieval. Of the 153 patients, 77 received metformin and 76 placebo. MAIN RESULTS AND THE ROLE OF CHANCE There was no reduction in the incidence of moderate-severe OHSS (Placebo (PLA) 12.2%, metformin (MET) = 16%, 95% CI -0.08-0.16, P = 0.66). There was no difference in total gonadotrophin dose (PLA = 1200, MET = 1200, 95% CI -118.67-118.67, P = 0.75), oocytes retrieved (PLA = 15, MET = 14, 95% CI -2.37-4.37, P = 0.66) or fertilisation rate (PLA = 60.7%, MET = 53.3%, 95% CI -0.96-14.94, P = 0.07). However, using metformin resulted in a reduced clinical pregnancy rate (CPR) per cycle started (PLA = 48.7%, MET = 28.6%, 95% CI 0.04-0.35, P = 0.02) and live birth rate (PLA = 51.6%, MET = 27.6%, 95% CI 0.05-0.40, P = 0.02). Furthermore, when ethnicity was taken into account there was a significant reduction in pregnancy outcome for the South Asian population irrespective of metformin or placebo use (CPR per cycle started, White Caucasian = 44.4%, South Asian = 19.4%; 95% CI 0.06-0.39, P = 0.01). LIMITATIONS, REASONS FOR CAUTION This study was only undertaken on an infertility population with PCOS with a limited duration of study medication use. WIDER IMPLICATIONS OF THE FINDINGS This is the first adequately powered RCT to assess the impact of metformin on OHSS in a high-risk group (women with PCOS) undergoing a GnRH antagonist cycle. It does not support the empirical prescribing of metformin as an adjunct to a GnRH antagonist treatment cycle. STUDY FUNDING/COMPETING INTERESTS None. TRIAL REGISTRATION NUMBER EudraCT number 2009-010952-81. TRIAL REGISTRATION DATE 21 September 2009. DATE OF FIRST PATIENT'S ENROLMENT 30 October 2009.
Collapse
Affiliation(s)
- S L Jacob
- Leeds Centre of Reproductive Medicine, Seacroft Hospital, Leeds LS14 6UH, UK
| | - C Brewer
- Leeds Centre of Reproductive Medicine, Seacroft Hospital, Leeds LS14 6UH, UK
| | - T Tang
- Regional Fertility Centre, Royal Maternity Hospital, Belfast BT12 6BA, UK
| | - H M Picton
- Leeds Centre of Reproductive Medicine, Seacroft Hospital, Leeds LS14 6UH, UK
| | - J H Barth
- Blood Sciences, Leeds General Infirmary, Leeds LS1 3EX, UK
| | - A H Balen
- Leeds Centre of Reproductive Medicine, Seacroft Hospital, Leeds LS14 6UH, UK
| |
Collapse
|
6
|
Koo HS, Cha SH, Kim HO, Song IO, Min EG, Yang KM, Park CW. A high response to controlled ovarian stimulation induces premature luteinization with a negative impact on pregnancy outcomes in a gonadotropin-releasing hormone antagonist cycle. Clin Exp Reprod Med 2016; 42:149-55. [PMID: 26816874 PMCID: PMC4724599 DOI: 10.5653/cerm.2015.42.4.149] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 10/29/2015] [Accepted: 11/11/2015] [Indexed: 11/17/2022] Open
Abstract
Objective The goal of this study was to investigate the relationship between serum progesterone (P4) levels on the day of human chorionic gonadotropin (hCG) administration and the pregnancy rate among women undergoing controlled ovarian stimulation for in vitro fertilization (IVF) or intracytoplasmic sperm injection-embryo transfer (ICSI-ET) using a flexible antagonist protocol. Methods This prospective study included 200 IVF and ICSI-ET cycles in which a flexible antagonist protocol was used. The patients were divided into five distinct groups according to their serum P4 levels at the time of hCG administration (0.80, 0.85, 0.90, 0.95, and 1.00 ng/mL). The clinical pregnancy rate (CPR) was calculated for each P4 interval. Statistically significant differences were observed at a serum P4 level of 0.9 ng/mL. These data suggest that a serum P4 concentration of 0.9 ng/mL may represent the optimal threshold level for defining premature luteinization (PL) based on the presence of a significant negative impact on the CPR. Results The CPR for each round of ET was significantly lower in the PL group defined using this threshold (25.8% vs. 41.8%; p=0.019), and the number of oocytes retrieved was significantly higher than in the non-PL group (17.3±7.2 vs. 11.0±7.2; p=0.001). Elevated serum P4 levels on the day of hCG administration were associated with a reduced CPR, despite the retrieval of many oocytes. Conclusion Measuring serum P4 values at the time of hCG administration is necessary in order to determine the optimal strategy for embryo transfer.
Collapse
Affiliation(s)
- Hwa Seon Koo
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine, Seoul, Korea
| | - Sun Hwa Cha
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine, Seoul, Korea
| | - Hye Ok Kim
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine, Seoul, Korea
| | - In Ok Song
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine, Seoul, Korea
| | - Eung Gi Min
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine, Seoul, Korea
| | - Kwang Moon Yang
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine, Seoul, Korea
| | - Chan Woo Park
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine, Seoul, Korea
| |
Collapse
|
7
|
Stimpfel M, Vrtacnik-Bokal E, Pozlep B, Virant-Klun I. Comparison of GnRH agonist, GnRH antagonist, and GnRH antagonist mild protocol of controlled ovarian hyperstimulation in good prognosis patients. Int J Endocrinol 2015; 2015:385049. [PMID: 25866508 PMCID: PMC4381687 DOI: 10.1155/2015/385049] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 02/24/2015] [Accepted: 02/25/2015] [Indexed: 11/30/2022] Open
Abstract
The reports on how to stimulate the ovaries for oocyte retrieval in good prognosis patients are contradictory and often favor one type of controlled ovarian hyperstimulation (COH). For this reason, we retrospectively analyzed data from IVF/ICSI cycles carried out at our IVF Unit in good prognosis patients (aged <38 years, first and second attempts of IVF/ICSI, more than 3 oocytes retrieved) to elucidate which type of COH is optimal at our condition. The included patients were undergoing COH using GnRH agonist, GnRH antagonist or GnRH antagonist mild protocol in combination with gonadotrophins. We found significant differences in the average number of retrieved oocytes, immature oocytes, fertilized oocytes, embryos, transferred embryos, embryos frozen per cycle, and cycles with embryo freezing between studied COH protocols. Although there were no differences in live birth rate (LBR), miscarriages, and ectopic pregnancies between compared protocols, pregnancy rate was significantly higher in GnRH antagonist mild protocol in comparison with both GnRH antagonist and GnRH agonist protocols and cumulative LBR per cycle was significantly higher in GnRH antagonist mild protocol in comparison to GnRH agonist protocol. Our data show that GnRH antagonist mild protocol of COH could be the best method of choice in good prognosis patients.
Collapse
Affiliation(s)
- Martin Stimpfel
- Department of Obstetrics and Gynaecology, University Medical Centre Ljubljana, Slajmerjeva 3, SI-1000 Ljubljana, Slovenia
| | - Eda Vrtacnik-Bokal
- Department of Obstetrics and Gynaecology, University Medical Centre Ljubljana, Slajmerjeva 3, SI-1000 Ljubljana, Slovenia
| | - Barbara Pozlep
- Department of Obstetrics and Gynaecology, University Medical Centre Ljubljana, Slajmerjeva 3, SI-1000 Ljubljana, Slovenia
| | - Irma Virant-Klun
- Department of Obstetrics and Gynaecology, University Medical Centre Ljubljana, Slajmerjeva 3, SI-1000 Ljubljana, Slovenia
- *Irma Virant-Klun:
| |
Collapse
|
8
|
Özmen B, Şükür Y, Seval M, Ateş C, Atabekoğlu C, Sönmezer M, Berker B. Dual suppression with oral contraceptive pills in GnRH antagonist cycles for patients with polycystic ovary syndrome undergoing intracytoplasmic sperm injection. Eur J Obstet Gynecol Reprod Biol 2014; 183:137-40. [DOI: 10.1016/j.ejogrb.2014.10.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 08/23/2014] [Accepted: 10/22/2014] [Indexed: 11/25/2022]
|
9
|
Singh N, Naha M, Malhotra N, Lata K, Vanamail P, Tiwari A. Comparison of gonadotropin-releasing hormone agonist with GnRH antagonist in polycystic ovary syndrome patients undergoing in vitro fertilization cycle: Retrospective analysis from a tertiary center and review of literature. J Hum Reprod Sci 2014; 7:52-7. [PMID: 24829532 PMCID: PMC4018799 DOI: 10.4103/0974-1208.130852] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2013] [Revised: 11/06/2013] [Accepted: 02/26/2014] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION: Polycystic ovary syndrome (PCOS) is one of the most common infertility factor for which women are enrolled in in vitro fertilization (IVF) technique. In the recent years, gonadotropin releasing hormone antagonist protocol has emerged as the protocol of choice for controlled ovarian hyperstimulation in these patients. OBJECTIVES: The objective of the present study is to compare conventional long agonist protocol with fixed antagonist protocol in PCOS patients undergoing IVF cycle. MATERIALS AND METHODS: Retrospective analysis of 4 years data of a single center from northern India. Totally 81 patients who had long agonist protocol were compared with 36 patients with similar baseline characteristics who had antagonist protocol. RESULT: Total dose of gonadotropin required was significantly lower (P - 0.004) in the antagonist group. There was no significant difference in pregnancy rate or incidence of ovarian hyperstimulation syndrome between two groups. Cycle cancellation due to arrest of follicular growth was significantly higher in the antagonist group (P - 0.027). CONCLUSION: More randomized control trials and meta-analysis are required before replacing conventional long agonist protocol with antagonist protocol in patients with polycystic ovary syndrome.
Collapse
Affiliation(s)
- Neeta Singh
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Moumita Naha
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Neena Malhotra
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Kusum Lata
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - P Vanamail
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Abnish Tiwari
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
10
|
Is a GnRH antagonist protocol better in PCOS patients? A meta-analysis of RCTs. PLoS One 2014; 9:e91796. [PMID: 24642641 PMCID: PMC3958392 DOI: 10.1371/journal.pone.0091796] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 02/14/2014] [Indexed: 11/25/2022] Open
Abstract
Objective To review published randomized controlled trials (RCTs) evaluating the outcomes of in vitro fertilization/intra-cytoplasmic sperm injection (IVF/ICSI) utilization of gonadotropin-releasing hormone (GnRH) antagonists for ovarian stimulation in polycystic ovarian syndrome (PCOS) patients compared with classic luteal long agonist protocols. Design A meta-analysis of prospective randomized trials published in English between 2002 and 2013. Patient(s) and Interventions Nine RCTs examining PCOS patients undergoing IVF/ICSI including 588 women who underwent long agonist protocols and 554 women who underwent GnRH antagonist protocols. Main Outcome Measure(s) Clinical pregnancy rate (CPR), ongoing pregnancy rate (OPR) and ovarian hyperstimulation syndrome (OHSS) rate. Result(s) Nine RCTs were included in this analysis. The CPR-per-embryo transferred was similar in the two groups (relative risk (RR): 0.97, 95% confidence interval (CI): 0.85–1.10). Non-significant estimates comparing the two protocols were found for age, BMI, total dose of gonadotropin administered, number of days of stimulation and number of oocytes retrieved. After meta-analysis of 4 of the RCTs, it was concluded that a GnRH antagonist protocol is better than an agonist long protocol to reduce the rate of severe OHSS (odds ratio (OR): 1.56, 95% CI: 0.29–8.51). Conclusion(s) With respect to CPR, a GnRH antagonist protocol is similar to a GnRH agonist long protocol. However, for severe OHSS, a GnRH antagonist protocol is significantly better in PCOS patients.
Collapse
|
11
|
Rinaldi L, Lisi F, Selman H. Mild/minimal stimulation protocol for ovarian stimulation of patients at high risk of developing ovarian hyperstimulation syndrome. J Endocrinol Invest 2014; 37:65-70. [PMID: 24464452 DOI: 10.1007/s40618-013-0021-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2013] [Accepted: 11/17/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Recently, an increased scientific interest was focused on mild approaches for ovarian stimulation in clinical practice. Milder stimulation aims to develop safer and more patient-friendly protocols which are more physiological, less drug use, less expensive and the risks of treatment are highly minimized. AIM To investigate the efficacy and safety of a mild ovarian stimulation protocol in patients at high risk of developing ovarian hyperstimulation syndrome (OHSS), compared to conventional long down-regulation protocol. SUBJECTS AND METHODS This a prospective, open, randomized study, included 349 infertile patients considered at high risk of developing OHSS, undergoing in vitro fertilization treatment in two private assisted reproduction centers. The patients were randomized into two groups: group A (n = 148) had a mild/minimal stimulation protocol of recombinant FSH (rFSH) combined with GnRH antagonist. Group B (n = 201) (control group) had a standard long protocol of rFSH combined with GnRH agonist. RESULTS There was no significant difference observed between the two groups regarding the mean number of oocytes retrieved per patient, mature metaphase II oocytes, fertilization rate, and embryo cleavage rate. Significantly higher implantation rate (21.5 vs 14.5 %) (p < 0.05), pregnancy rate (37.7 vs 23.4 %) (p < 0.05), and delivery rate (32.8 vs 20.1 %) (p < 0.05) were observed in favor of groups A compared to group B. Lower proportion of patients (4.7 %), though not statistically significant, has developed OHSS in group A compared to group B (8.4 %). CONCLUSION Our study shows that mild stimulation regimen is highly effective for ovarian stimulation of patients who have experienced OHSS complication without increasing the risk of OHSS.
Collapse
Affiliation(s)
- L Rinaldi
- RISEL-One Day Medical Center, Via Attilio Ambrosini 114, 00147, Rome, Italy,
| | | | | |
Collapse
|
12
|
Pregnancy and neonatal outcomes following luteal GnRH antagonist administration in patients with severe early OHSS. Hum Reprod 2013; 28:1929-42. [DOI: 10.1093/humrep/det114] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
|
13
|
Kaur H, Krishna D, Shetty N, Krishnan S, Srinivas M, Rao KA. A prospective study of GnRH long agonist versus flexible GnRH antagonist protocol in PCOS: Indian experience. J Hum Reprod Sci 2012; 5:181-6. [PMID: 23162356 PMCID: PMC3493832 DOI: 10.4103/0974-1208.101017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2011] [Revised: 01/07/2012] [Accepted: 04/03/2012] [Indexed: 11/09/2022] Open
Abstract
CONTEXT: Pathogenesis of uterine synechia remains unsolved, the causal relationship between synechia and infertility is not clearly established. AIMS: To evaluate the rabbit as an experimental model for Asherman's syndrome using the endometrial curettage as trigger mechanism then to evaluate its impact on fertility. SETTINGS AND DESIGN: Experimental study MATERIALS AND METHODS: 13 female rabbits. All submitted traumatic endometrial curettage. Animals of Group 1 (n = 7) were sacrificed at various times following surgery (day 7, 15 and 30), animals of Group 2 (n = 6) were bred and sacrificed during pregnancy. Main outcome were synechia occurring, number of implanted fetus, lumen surface/ global horn perimeter ratio (LS-GHP ratio) and epithelium thickness. STATISTICAL ANALYSIS: Means were compared using Student ‘t’ test (P < 0.05 was considered significant). Number of implantation sites of two horns were compared with the Wilcoxon test. RESULTS: No synechia have been observed. Examinations at Day 7, 15 and 30 demonstrate a complete regeneration of endometrium. We observed a significant diminished LS-GHP ratio at day 7 (0.042 ± 0.004 vs 0.074 ± 0.002 mm; P = 0.013) with a higher simple columnar epithelium compared to control (16.6 ± 3.39 vs 10.98 ± 1.7; P = 0.001). We observed a diminished ovum implantation in traumatized horns, even if it was not statistically significant. CONCLUSION: Even if no intrauterine adhesion were observed, this model represents a pathogenesis condition in the rabbit similar to intrauterine adhesions observed in the human with negative impact on implantation.
Collapse
Affiliation(s)
- Harpreet Kaur
- Department of Reproductive Medicine Medicine Unit, Bangalore Assisted Conception Centre, Bangalore, India
| | | | | | | | | | | |
Collapse
|
14
|
Sills ES, Collins GS, Salem SA, Jones CA, Peck AC, Salem RD. Balancing selected medication costs with total number of daily injections: a preference analysis of GnRH-agonist and antagonist protocols by IVF patients. Reprod Biol Endocrinol 2012; 10:67. [PMID: 22935199 PMCID: PMC3447708 DOI: 10.1186/1477-7827-10-67] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Accepted: 08/27/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND During in vitro fertilization (IVF), fertility patients are expected to self-administer many injections as part of this treatment. While newer medications have been developed to substantially reduce the number of these injections, such agents are typically much more expensive. Considering these differences in both cost and number of injections, this study compared patient preferences between GnRH-agonist and GnRH-antagonist based protocols in IVF. METHODS Data were collected by voluntary, anonymous questionnaire at first consultation appointment. Patient opinion concerning total number of s.c. injections as a function of non-reimbursed patient cost associated with GnRH-agonist [A] and GnRH-antagonist [B] protocols in IVF was studied. RESULTS Completed questionnaires (n = 71) revealed a mean +/- SD patient age of 34 +/- 4.1 yrs. Most (83.1%) had no prior IVF experience; 2.8% reported another medical condition requiring self-administration of subcutaneous medication(s). When out-of-pocket cost for [A] and [B] were identical, preference for [B] was registered by 50.7% patients. The tendency to favor protocol [B] was weaker among patients with a health occupation. Estimated patient costs for [A] and [B] were $259.82 +/- 11.75 and $654.55 +/- 106.34, respectively (p < 0.005). Measured patient preference for [B] diminished as the cost difference increased. CONCLUSIONS This investigation found consistently higher non-reimbursed direct medication costs for GnRH-antagonist IVF vs. GnRH-agonist IVF protocols. A conditional preference to minimize downregulation (using GnRH-antagonist) was noted among some, but not all, IVF patient sub-groups. Compared to IVF patients with a health occupation, the preference for GnRH-antagonist was weaker than for other patients. While reducing total number of injections by using GnRH-antagonist is a desirable goal, it appears this advantage is not perceived equally by all IVF patients and its utility is likely discounted heavily by patients when nonreimbursed medication costs reach a critical level.
Collapse
Affiliation(s)
- E Scott Sills
- Reproductive Research Division, Pacific Reproductive Center, PRC—Orange County, 10 Post, Irvine, CA, 92618, USA
| | - Gary S Collins
- Centre for Statistics in Medicine, Wolfson College Annexe, University of Oxford, Oxford, UK
| | - Shala A Salem
- Reproductive Research Division, Pacific Reproductive Center, PRC—Orange County, 10 Post, Irvine, CA, 92618, USA
| | - Christopher A Jones
- Global Health Economics Unit and Department of Surgery, UVM College of Medicine, Burlington, VT, USA
| | - Alison C Peck
- Reproductive Research Division, Pacific Reproductive Center, PRC—Orange County, 10 Post, Irvine, CA, 92618, USA
| | - Rifaat D Salem
- Reproductive Research Division, Pacific Reproductive Center, PRC—Orange County, 10 Post, Irvine, CA, 92618, USA
| |
Collapse
|
15
|
Caserta D, Lisi F, Marci R, Ciardo F, Fazi A, Lisi R, Moscarini M. Does supplementation with recombinant luteinizing hormone prevent ovarian hyperstimulation syndrome in down regulated patients undergoing recombinant follicle stimulating hormone multiple follicular stimulation for IVF/ET and reduces cancellation rate for high risk of hyperstimulation? Gynecol Endocrinol 2011; 27:862-6. [PMID: 21391759 DOI: 10.3109/09513590.2010.544133] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Aim of this study was to assess the efficacy of recombinant luteinizing hormone (rLH) supplementation in late follicular phase in multiple follicular stimulation with recombinant follicle stimulating hormone (rFSH) in Triptoreline down-regulated patients undergoing IVF, on preventing clinical OHSS and cycles cancellation for OHSS risk. Nine hundred ninety-nine patients aged ≤ 40 with basal FSH ≤ 12 mUI/Ml were down-regulated before starting rFSH stimulation for oocytes recovery. Patients were allocated in two groups: (A) (501 patients) treated with 150 IU of rFSH eventually adjusting rFSH dosage day 7 of stimulation until recombinant human chorionic gonadotropin (rhCG) administration, (B) (498 patients) treated with 150 IU of rFSH and 75 IU of rLH since day 7 of stimulation until rhCG administration and adjusting rFSH at the same day. E2 the day of rhCG was higher in group B (p < 0.0001); number of cycles cancelled in group A (42/8.3%) for risk of ovarian hyperstimulation syndrome (OHSS) was higher than group B (12/2.4%) (p < 0.000001). We observed an increase in pregnancies in group B compared with group A (16.8% vs 11.9%) (p < 0.05) and we observed also a larger number of clinical OHSS in group A than in group B (p < 0.05).
Collapse
Affiliation(s)
- Donatella Caserta
- Department of Woman Health and Territory's Medicine, University of Rome Sapienza, S. Andrea Hospital, Rome, Italy.
| | | | | | | | | | | | | |
Collapse
|
16
|
Scotti L, Irusta G, Abramovich D, Tesone M, Parborell F. Administration of a gonadotropin-releasing hormone agonist affects corpus luteum vascular stability and development and induces luteal apoptosis in a rat model of ovarian hyperstimulation syndrome. Mol Cell Endocrinol 2011; 335:116-25. [PMID: 21238536 DOI: 10.1016/j.mce.2011.01.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2010] [Revised: 12/22/2010] [Accepted: 01/05/2011] [Indexed: 10/18/2022]
Abstract
Ovarian hyperstimulation syndrome (OHSS) is a complication of ovarian stimulation with gonadotropins followed by the administration of human chorionic gonadotropin (hCG) to trigger the final steps of oocyte maturation. Gonadotropin-releasing hormone (GnRH) analogs are thought to be effective in preventing this complication and a clinical trial has found a lower incidence of OHSS in patients treated with these molecules. Our aim was to analyze the in vivo effect of a GnRH-I agonist on corpus luteum development and regression, ANGPT-1, ANGPT-2 and Tie-2 protein expression and luteal blood vessel stabilization, the expression of the steroidogenic acute regulatory protein (StAR) and the cytochrome P450 side-chain cleavage enzyme (P450scc) and cell proliferation, in ovaries from an OHSS rat model. To this end immature female Sprague-Dawley rats were hyperstimulated and treated with a GnRH-I agonist from the start of pregnant mare serum gonadotropin (PMSG) administration until the day of hCG injection for 5 consecutive days. Blood and tissue samples were collected 48h after hCG injection. Vascular endothelial growth factor VEGF levels were evaluated in the peritoneal fluid by ELISA. Serum progesterone and estradiol were measured by RIA. Histological features of sectioned ovaries were assessed in hematoxylin and eosin (H&E) stained slides. Luteal blood vessel stability, cell proliferation and apoptosis were assessed by immunohistochemistry for SMCA, PCNA, and TUNEL, respectively. P450scc, StAR, FLK-1, ANGPT-1, ANGPT-2, Tie-2 and PCNA protein levels were evaluated by Western blot from dissected corpora lutea (CL). The treatment with the GnRH-I agonist significantly decreased serum progesterone and estradiol levels as well as P450scc and StAR protein expression in the untreated OHSS group. In addition, the agonist significantly decreased the number of CL in the OHSS group, as compared with the untreated OHSS group. In the OHSS group, the area of periendothelial cells in the CL was larger than that of the control group. However, the treatment with the GnRH-I agonist significantly reduced the area of periendothelial cells in the CL in the OHSS group. The luteal levels of ANGPT-1 and its receptor Tie-2 significantly increased in the OHSS group when compared with the control group. Conversely, the administration of the GnRH-I agonist significantly decreased the levels of these factors in the CL from the OHSS group, as compared with the untreated OHSS group. In addition, the treatment with the GnRH-I agonist reduced the diameter of CL and decreased CL cell proliferation as compared with that observed in the untreated OHSS group. Finally, the GnRH-I agonist increased apoptosis in the CL from the OHSS group. In conclusion, these results show that GnRH-I agonist exerts diverse actions on the CL from a rat OHSS model. The decrease in P450scc, StAR, ANGPT-1 and Tie-2 expression, blood vessel stability and luteal proliferation leads to CL regression in the ovaries from OHSS rats. Moreover, our results suggest that the downregulation of ANGPT-1 and its receptor is a possible mechanism whereby GnRH-I agonists could prevent early OHSS.
Collapse
Affiliation(s)
- Leopoldina Scotti
- Instituto de Biología y Medicina Experimental--CONICET, Buenos Aires, Argentina
| | | | | | | | | |
Collapse
|
17
|
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
|
18
|
Busso CE, Garcia-Velasco JA, Simon C, Pellicer A. Prevention of OHSS: Current strategies and new insights. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2010. [DOI: 10.1016/j.mefs.2010.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
|
19
|
Hosseini MA, Aleyasin A, Saeedi H, Mahdavi A. Comparison of gonadotropin-releasing hormone agonists and antagonists in assisted reproduction cycles of polycystic ovarian syndrome patients. J Obstet Gynaecol Res 2010; 36:605-10. [DOI: 10.1111/j.1447-0756.2010.01247.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
20
|
Tehraninejad ES, Nasiri R, Rashidi B, Haghollahi F, Ataie M. Comparison of GnRH antagonist with long GnRH agonist protocol after OCP pretreatment in PCOs patients. Arch Gynecol Obstet 2010; 282:319-25. [DOI: 10.1007/s00404-010-1429-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2009] [Accepted: 03/08/2010] [Indexed: 12/18/2022]
|
21
|
Are gonadotropin-releasing hormone agonists losing popularity? Current trends at a large fertility center. Fertil Steril 2010; 93:101-8. [DOI: 10.1016/j.fertnstert.2008.09.048] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2008] [Revised: 09/09/2008] [Accepted: 09/11/2008] [Indexed: 11/23/2022]
|
22
|
Lainas TG, Sfontouris IA, Zorzovilis IZ, Petsas GK, Lainas GT, Alexopoulou E, Kolibianakis EM. Flexible GnRH antagonist protocol versus GnRH agonist long protocol in patients with polycystic ovary syndrome treated for IVF: a prospective randomised controlled trial (RCT). Hum Reprod 2009; 25:683-9. [DOI: 10.1093/humrep/dep436] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
23
|
Vela G, Luna M, Sandler B, Copperman AB. Advances and Controversies in Assisted Reproductive Technology. ACTA ACUST UNITED AC 2009; 76:506-20. [DOI: 10.1002/msj.20147] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
|
24
|
Tur-Kaspa I, Ezcurra D. GnRH antagonist, cetrorelix, for pituitary suppression in modern, patient-friendly assisted reproductive technology. Expert Opin Drug Metab Toxicol 2009; 5:1323-36. [PMID: 19761413 DOI: 10.1517/17425250903279969] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Gonadotropin-releasing hormone (GnRH) analogues are used routinely to prevent a premature luteinizing hormone (LH) surge in women undergoing assisted reproductive technology (ART) treatments. In contrast to GnRH agonists, antagonists produce rapid and reversible suppression of LH with no initial flare effect. OBJECTIVE To review the role of cetrorelix, the first GnRH antagonist approved for the prevention of premature LH surges during controlled ovarian stimulation in modern ART. METHOD A review of published literature on cetrorelix. RESULTS Both multiple- and single-dose cetrorelix protocols were shown to be at least as effective as long GnRH agonist regimens for pituitary suppression in Phase II/III clinical trials. Furthermore, cetrorelix co-treatment resulted in similar live birth rates but a shorter duration of gonadotropin stimulation, a lower total gonadotropin dose requirement and lower incidence of ovarian hyperstimulation syndrome compared with long agonist regimens. A single-dose cetrorelix protocol further decreased the number of injections required. Preliminary studies have also produced promising data on the use of cetrorelix in modified ART protocols, such as frozen embryo transfer and donor oocyte recipient cycles. CONCLUSION Cetrorelix offers a potential therapeutic alternative to GnRH agonists during controlled ovarian stimulation and has become an integral part of modern, patient-friendly reproductive medicine.
Collapse
Affiliation(s)
- Ilan Tur-Kaspa
- Institute for Human Reproduction (IHR) and Reproductive Genetics Institute, Chicago, IL, USA.
| | | |
Collapse
|
25
|
Effects of gonadotropin-releasing hormone antagonists on the expression of vascular endothelial growth factor and its receptors in a rat model of ovarian hyperstimulation syndrome. Chin Med J (Engl) 2008. [DOI: 10.1097/00029330-200812010-00014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
|
26
|
Aramwit P, Pruksananonda K, Kasettratat N, Jammeechai K. Risk factors for ovarian hyperstimulation syndrome in Thai patients using gonadotropins for in vitro fertilization. Am J Health Syst Pharm 2008; 65:1148-1153. [DOI: 10.2146/ajhp070566] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Affiliation(s)
- Pornanong Aramwit
- Department of Pharmacy, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
| | | | - Narat Kasettratat
- Department of Pharmacy, Faculty of Pharmaceutical Sciences, Chulalongkorn University. Lt
| | | |
Collapse
|
27
|
Tazegül A, Görkemli H, Özdemir S, Aktan TM. Comparison of multiple dose GnRH antagonist and minidose long agonist protocols in poor responders undergoing in vitro fertilization: a randomized controlled trial. Arch Gynecol Obstet 2008; 278:467-72. [DOI: 10.1007/s00404-008-0620-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2008] [Accepted: 02/26/2008] [Indexed: 11/24/2022]
|
28
|
Fauser BCJM, Diedrich K, Devroey P. Predictors of ovarian response: progress towards individualized treatment in ovulation induction and ovarian stimulation. Hum Reprod Update 2007; 14:1-14. [PMID: 18006561 DOI: 10.1093/humupd/dmm034] [Citation(s) in RCA: 152] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Ovarian stimulation is applied in the clinic to restore mono-ovulatory cycles in anovulatory women (ovulation induction) or to induce the development of multiple dominant follicles for assisted reproduction. Ovarian response is the endocrine and follicular reaction of the ovaries to stimulation. Achieving an appropriate ovarian response to anti-estrogens or exogenous gonadotrophins is central to ovulation induction and ovarian stimulation protocols. However, achieving an adequate response, without cycle cancellation or adverse events related to under- or over-stimulation, is complicated by high intra- and inter-individual variability. To predict each patient's ovarian response to medication for ovarian stimulation and to individualize the starting dose of exogenous gonadotrophin or the need for exogenous luteinizing hormone, various clinical, endocrine, ovarian ultrasonographic and genetic characteristics have been explored. Some of these features have been incorporated into prediction models. In this review, the methodology behind predictive factors and prediction models and their potential clinical applicability across ovulation induction and ovarian stimulation are explored.
Collapse
Affiliation(s)
- B C J M Fauser
- Department of Reproductive Medicine and Gynecology, University Medical Center, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
| | | | | | | |
Collapse
|
29
|
Eldar-Geva T, Zylber-Haran E, Babayof R, Halevy-Shalem T, Ben-Chetrit A, Tsafrir A, Varshaver I, Brooks B, Margalioth EJ. Similar outcome for cryopreserved embryo transfer following GnRH-antagonist/GnRH-agonist, GnRH-antagonist/HCG or long protocol ovarian stimulation. Reprod Biomed Online 2007; 14:148-54. [PMID: 17298715 DOI: 10.1016/s1472-6483(10)60781-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The pregnancy rates after triggering of final oocyte maturation with gonadotrophin-releasing hormone (GnRH) agonist in GnRH-antagonist ovarian stimulation protocols are lower than those following triggering with human chorionic gonadotrophin (HCG). Furthermore, lower pregnancy rates following GnRH-antagonist protocols compared with long GnRH-agonist protocols have been reported. The differences might be due to an impact on oocyte number and quality or on the endometrium. If any stimulation protocol had a negative impact on oocyte quality, then further evidence of this effect would be observed following frozen-thawed embryo transfer originating from that stimulation cycle. The outcome of frozen-thawed embryo transfer was retrospectively analysed using the long protocol with triptorelin depot 3.75 mg (n = 215) or 0.1 mg/day (n = 83), or GnRH-antagonist protocol with either HCG (n = 69) or GnRH-agonist (n = 25) for final oocyte maturation. The outcomes measured were implantation rate, clinical pregnancy rate, ongoing pregnancy rate and embryo survival rate. All outcomes were similar in the four groups. It is concluded that the potential for frozen-thawed embryos to implant and develop following transfer is independent of the GnRH-analogue and the final oocyte maturation protocol used in the collection cycle. Lower IVF embryo transfer success using GnRH-antagonist/GnRH-agonist protocol does not appear to be related to an adverse effect on oocyte quality.
Collapse
Affiliation(s)
- Talia Eldar-Geva
- IVF Unit, Department of Obstetrics and Gynecology, Shaare Zedek Medical Centre, Ben-Gurion University of the Negev, Jerusalem, 9103, Israel.
| | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Acevedo B, Gomez-Palomares JL, Ricciarelli E, Hernández ER. Triggering ovulation with gonadotropin-releasing hormone agonists does not compromise embryo implantation rates. Fertil Steril 2006; 86:1682-7. [PMID: 17074344 DOI: 10.1016/j.fertnstert.2006.05.049] [Citation(s) in RCA: 122] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2005] [Revised: 05/16/2006] [Accepted: 05/16/2006] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the implant capacity of embryos derived from oocytes matured with a bolus of GnRH agonist. DESIGN Donors were randomly assigned to a protocol using either GnRH agonist or recombinant (r) hCG to trigger ovulation. Analysis of variance, Student t test, and Fisher exact test were used where appropriate. SETTING Private clinical setting. PATIENT(S) Young voluntary donors receiving GnRH agonist (n = 30) or rhCG (n = 30). Eighty-nine patients received oocytes. INTERVENTION(S) Controlled ovarian stimulation was carried out with GnRH antagonist and FSH/LH in a step-down protocol. Donors received a single bolus of GnRH agonist (0.2 mg) or rhCG (250 microg). The endometrial tissue of recipient patients was prepared with oral E(2) and P. MAIN OUTCOME MEASURE(S) Pregnancy and implantation rates and ovarian hyperstimulation syndrome (OHSS) in an IVF donor program. RESULT(S) No significant differences in the number of retrieved oocytes (327 vs. 288), MII oocytes (70% vs. 76%), fertilization (80% vs. 65%,), pregnancy/transfer (55% vs. 59%), and implantation rates (29% vs. 32%) were found between recipients whose embryos originated from donors in whom final oocyte maturation was triggered with GnRH agonist and those whose donors received hCG. Significant differences in luteal phase length (4.16 + 0.70 days vs. 13.63 + 2.12 days) and in OHSS (0/30 vs. 5/30) were seen between donors ovulated with the agonist and the donors in whom ovulation was triggered with hCG. CONCLUSION(S) In controlled ovarian stimulation IVF donor cycles, GnRH agonists trigger ovulation and induce luteolysis but do not compromise embryo implantation capacity.
Collapse
Affiliation(s)
- Belen Acevedo
- Clinica de Medicina de la Reproduccion y Ginecologia FivMadrid, Madrid, Spain
| | | | | | | |
Collapse
|
31
|
Bahceci M, Ulug U, Tosun S, Erden HF, Bayazit N. Impact of coasting in patients undergoing controlled ovarian stimulation with the gonadotropin-releasing hormone antagonist cetrorelix. Fertil Steril 2006; 85:1523-5. [PMID: 16566935 DOI: 10.1016/j.fertnstert.2005.10.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2005] [Revised: 10/07/2005] [Accepted: 10/07/2005] [Indexed: 11/22/2022]
Abstract
Coasting is the most popular modality for the prevention of ovarian hyperstimulation syndrome, but this procedure has not been evaluated in patients undergoing controlled ovarian hyperstimulation (COH) with GnRH antagonists. The impact of coasting in a cycle in which GnRH antagonist is used was evaluated in 29 women, and it was found that coasting did not deleteriously affect the outcome in high-responder patients undergoing COH with GnRH antagonists.
Collapse
Affiliation(s)
- Mustafa Bahceci
- Bahceci Women's Health Care Center, German Hospital, Istanbul, Turkey.
| | | | | | | | | |
Collapse
|
32
|
Abstract
FSH is a glycoprotein hormone consisting of two peptide subunits. The role of FSH in folliculogenesis is well known: to stimulate the formation of a large pre-ovulatory follicle that, because of its FSH-dependent maturation, is capable of ovulation and forming a corpus luteum in response to the mid-cycle surge of LH. FSH is widely used in ovarian stimulation for assisted reproduction techniques. Ovarian stimulation protocols combine the use of human menopausal gonadotrophin, urinary FSH or recombinant FSH with gonadotrophin-releasing hormone (GnRH) agonists or antagonists in order to increase oocyte number and to avoid premature LH surge. Recently, the availability of recombinant LH has permitted new stimulation protocols, combining recombinant FSH, recombinant LH and GnRH antagonists. Due to the limitations of the new Italian law in terms of the number of oocytes that can be fertilized, protocols with a softer ovarian stimulation are now considered, reducing risk of ovarian hyperstimulation syndrome, multiple pregnancies and emotional and physical burdens on the patients. Long-acting FSH preparations are also under clinical study. Knowledge of the stereochemical three-dimensional structure of FSH and its receptor will allow the study of new non-peptide orally administered molecules that fit the FSH receptors.
Collapse
Affiliation(s)
- Walter Vegetti
- Infertility Unit, Fondazione I.R.C.C.S. Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Milan, Italy.
| | | |
Collapse
|
33
|
Cristello F, Cela V, Artini PG, Genazzani AR. Therapeutic strategies for ovulation induction in infertile women with polycystic ovary syndrome. Gynecol Endocrinol 2005; 21:340-52. [PMID: 16390783 DOI: 10.1080/09513590500463360] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Polycystic ovary syndrome (PCOS) is a heterogeneous disorder characterized by hirsutism, obesity, hyperandrogenism and insulin resistance. The syndrome is often accompanied by infertility because of anovulation. Many approaches have been proposed to solve this problem, with the most commonly used therapies being ovarian drilling and pharmacological ovulation induction. Ovarian drilling is a procedure in which a laser fiber or electro-surgical needle punctures the ovary four to ten times. Side-effects are rare and often related to surgery itself. Pharmacological strategies include administration of metformin and insulin-sensitizing agents, clomiphene citrate (CC), gonadotropins and aromatase inhibitors. Metformin appears valuable in increasing ovulation rate, menstrual cyclicity and pregnancy rate. CC is an oral estrogen antagonist that raises circulating concentrations of follicle-stimulating hormone (FSH) and induces follicular growth in most women with PCOS and anovulation. Failure to respond is associated with high body mass index and high androgen levels. Aromatase inhibitors mimic the central reduction of negative feedback through which CC works. Ovulation induction with recombinant FSH has proved successful, but treatment requires skill and experience to avoid multiple pregnancies and ovarian hyperstimulation syndrome. The hypothetical deleterious effects of the high luteinizing hormone concentrations observed in PCOS patients seem to be related to the concomitant hyperinsulinemia (and/or insulin resistance). A thorough understanding of the syndrome and a careful assessment of each patient are the mainstays for choosing an appropriate treatment regimen.
Collapse
Affiliation(s)
- Francesca Cristello
- Department of Reproductive Medicine and Child Development, Division of Obstetrics and Gynecology, 'S. Chiara' Hospital, University of Pisa, Pisa, Italy.
| | | | | | | |
Collapse
|