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Cao X, Chang HY, Xu JY, Zheng Y, Xiang YG, Xiao B, Geng XJ, Ni LL, Chu XY, Tao SB, He Y, Mao GH. The effectiveness of different down-regulating protocols on in vitro fertilization-embryo transfer in endometriosis: a meta-analysis. Reprod Biol Endocrinol 2020; 18:16. [PMID: 32113479 PMCID: PMC7049222 DOI: 10.1186/s12958-020-00571-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 02/10/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND To investigate the effectiveness of the GnRH-a ultra-long protocol, GnRH-a long protocol, and GnRH-a short protocol used in in vitro fertilization-embryo transfer (IVF-ET) in infertile women with endometriosis. METHODS We searched PubMed, Embase, Web of Science, Cochrane Library, Elsevier Science Direct, OA Library, Google Scholar, China National Knowledge Infrastructure (CNKI), Wanfang Data Knowledge Service Platform, China Science and Technology Journal database, and the China Biology Medicine disc for randomized controlled trials (RCTs) and observational studies (non-RCTs) to evaluate the efficacy of the GnRH-a ultra-long protocol, GnRH-a long protocol, and GnRH-a short protocol in IVF-ET in infertile patients with endometriosis. RESULTS A total of 21 studies in compliance with the standard literature were included, and RCT and non-RCT studies were analyzed separately. This meta-analysis showed that the GnRH-a ultra-long protocol could improve the clinical pregnancy rate of infertile patients in RCT studies, especially in patients with stages III-IV endometriosis (RR = 2.04, 95% CI: 1.37~3.04, P < 0.05). However, subgroup analysis found the different down-regulation protocols provided no significant difference in improving clinical outcomes in patients with endometriosis in the non-RCT studies. CONCLUSION This study suggests that the GnRH-a ultra-long protocol can improve the clinical pregnancy rate of the patients with stages III-IV endometriosis in RCT studies. Although it is generally believed that the results of RCT are more reliable, the conclusions of the non-RCT studies cannot be easily neglect, which let us draw conclusions more cautious.
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Affiliation(s)
- Xue Cao
- Reproductive Medical Center, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, 450014, China
| | - Hong-Yang Chang
- Reproductive Medical Center, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, 450014, China
| | - Jun-Yan Xu
- Reproductive Medical Center, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, 450014, China
| | - Yi Zheng
- Wuhan Institute of Dermatology and Venerology, Wuhan, China
| | - Yun-Gai Xiang
- Reproductive Medical Center, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, 450014, China
| | - Bing Xiao
- Reproductive Medical Center, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, 450014, China
| | - Xu-Jing Geng
- Reproductive Medical Center, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, 450014, China
| | - Li-Li Ni
- Reproductive Medical Center, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, 450014, China
| | - Xi-Ying Chu
- Reproductive Medical Center, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, 450014, China
| | - Shi-Bo Tao
- Reproductive Medical Center, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, 450014, China
| | - Yan He
- Teaching Office, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, 450014, China.
| | - Gen-Hong Mao
- Reproductive Medical Center, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, 450014, China.
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Polat M, Yaralı İ, Boynukalın K, Yaralı H. In vitro fertilization for endometriosis-associated infertility. ACTA ACUST UNITED AC 2015; 11:633-41. [PMID: 26395161 DOI: 10.2217/whe.15.50] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Endometriosis is an enigmatic disease affecting 10-15% of reproductive aged women and is encountered in 25-35% of women suffering from infertility. IVF is an effective tool to overcome endometriosis-associated infertility when expectant management or surgery fails. Direct IVF should be envisioned if the female age is greater than 38 year and infertility is long lasting. Likewise, semen characteristics or tubal status that is incompatible with natural conception mandates going straight to IVF. IVF, not only bypasses the distortion of pelvic anatomy associated with advanced stage endometriosis, but also removes gametes from a hostile peritoneal environment. In this article, we address the impact, if any, of endometriosis and endometriomason IVF outcome, whether surgical treatment of early-stage disease, endometriomas or deep infiltrating endometriosis would enhance pregnancy rates in IVF, which protocol to employ for controlled ovarian hyperstimulation for IVF and finally the impact, if any, of controlled ovarian hyperstimulation for IVF on progression of endometriosis.
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Affiliation(s)
- Mehtap Polat
- Anatolia IVF & Women's Health Center, Ankara, Turkey
| | - İrem Yaralı
- Anatolia IVF & Women's Health Center, Ankara, Turkey
| | | | - Hakan Yaralı
- Anatolia IVF & Women's Health Center, Ankara, Turkey.,Department of Obstetrics & Gynecology, School of Medicine, Hacettepe University, Turkey
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Abstract
ABSTRACT
Aim and Objectives
The aim of this study was to see if the fertility outcome improved when IVF/ICSI was done after administration of GnRH analogs and cyst aspiration in comparison with patients in whom either only cyst aspiration or only GnRh analogs were administered.
Materials and methods
This was a prospective study done in a tertiary level ART center which included 30 patients over a span of 5 years from 2004 to 2009. All of them had endometriomas and underwent assisted reproductive techniques (ART) either after cyst aspiration with or without GnRH analog pretreatment or only GnRH analog pretreatment.
Depending on the pretreatment received, they were classified into three groups:
• Group B: Both GnRH analog and cyst aspiration
• Group C: Only cyst aspiration
• Group G: Only GnRH analog.
The patients were not randomized.
The number of days required for stimulation, total dose of stimulation required, number of oocytes obtained, quality of embryos, and the pregnancy rates for each group were tabulated for comparison.
Statistical analysis
The significance of the difference in ART outcome after the different modalities of pretreatment, which was estimated in terms of pregnancy rates was evaluated by calculating the p-value.
Observations and results
Significant difference was observed between the pregnancy rates in the three groups, with the maximum pregnancy rate in group B, followed by the group G and then the group C. The p-value showed a trend, though not statistically significant, indicating the need for larger prospective studies with greater number of subjects.
Conclusion
Pretreating endometriomas by aspirating the cysts and administering three doses of GnRH analog depot preparation prior to IVF/ICSI seems to be better than administering GnRH analog depot preparation alone or aspirating the cysts alone in terms of the number of days required for stimulation, the number of oocytes obtained, and the clinical pregnancy rates.
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Tavmergen E, Ulukus M, Goker ENT. Long-term use of gonadotropin-releasing hormone analogues before IVF in women with endometriosis. Curr Opin Obstet Gynecol 2007; 19:284-8. [PMID: 17495647 DOI: 10.1097/gco.0b013e3281053a52] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
PURPOSE OF REVIEW To discuss the relationship between endometriosis and infertility, the impact of endometriosis on assisted reproductive techniques and also the benefits of prolonged use of gonadotropin-releasing hormone analogue before IVF in women with endometriosis. RECENT FINDINGS The available evidence suggests that endometriosis is strongly associated with infertility. Many studies indicate lower pregnancy and implantation rates even in assisted reproductive cycles in women with endometriosis. It is well known that medical suppression of endometriosis does not appear to be warranted for endometriosis-associated infertility. Prolonged pretreatment with gonadotropin-releasing hormone analogue before IVF has been reported to improve clinical pregnancy rates in infertile women with endometriosis. SUMMARY Based on the recently published data, infertile women with endometriosis may benefit from long-term pretreatment of gonadotropin-releasing hormone analogue prior to IVF.
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Affiliation(s)
- Erol Tavmergen
- Family Planning-Infertility Research and Treatment Center, Ege University School of Medicine, Bornova-Izmir, Turkey.
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Sallam HN, Garcia-Velasco JA, Dias S, Arici A. Long-term pituitary down-regulation before in vitro fertilization (IVF) for women with endometriosis. Cochrane Database Syst Rev 2006; 2006:CD004635. [PMID: 16437491 PMCID: PMC8195082 DOI: 10.1002/14651858.cd004635.pub2] [Citation(s) in RCA: 105] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Women with endometriosis who are treated with in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) have a lower pregnancy rate compared to women with tubal factor infertility. It has been suggested that the administration of gonadotrophin releasing hormone (GnRH) agonists for a few months prior to IVF or ICSI increases the pregnancy rate. OBJECTIVES To determine the effectiveness of administering GnRH agonists for three to six months prior to IVF or ICSI in women with endometriosis. SEARCH STRATEGY We used computer searches of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, the National Research Register (NRR) and the MDSG Specialised Register of controlled trials. We handsearched proceedings of annual meetings of the American Society for Reproductive Medicine (ASRM) and the European Society for Human Reproduction and Embryology (ESHRE). We reviewed lists of references in original research and review articles. We contacted experts in various countries to identify unpublished trials. SELECTION CRITERIA We included randomised controlled trials using any GnRH agonist prior to IVF or ICSI to treat women with any degree of endometriosis diagnosed by laparoscopy or laparotomy DATA COLLECTION AND ANALYSIS Two independent review authors abstracted data (HNS and JGV). We sent e-mails to investigators to seek additional information. We assessed the validity of each study using the methods suggested in the Cochrane Handbook. The data were checked by the third review author (SD) and any disagreement was resolved by arbitration with the fourth review author (AA). We generated 2 x 2 tables for principal outcome measures. The Peto-modified Mantel-Haenszel technique was used to calculate odds ratios (OR) and assess statistical heterogeneity between studies. MAIN RESULTS Three randomised controlled trials (with 165 women) were included. The live birth rate per woman was significantly higher in women receiving the GnRH agonist compared to the control group (OR 9.19, 95% CI 1.08 to 78.22). However, this was based on one trial reporting "viable pregnancy" only. The clinical pregnancy rate per woman was also significantly higher (three studies: OR 4.28, 95% CI 2.00 to 9.15). The information on miscarriage rates came from two trials with high heterogeneity and, therefore, results of the meta-analysis were doubtful. The included studies provided insufficient data to investigate the effects of administration of GnRH agonists on multiple or ectopic pregnancies, fetal abnormalities or other complications. AUTHORS' CONCLUSIONS The administration of GnRH agonists for a period of three to six months prior to IVF or ICSI in women with endometriosis increases the odds of clinical pregnancy by fourfold. Data regarding adverse effects of this therapy on the mother or fetus are not available at present.
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Affiliation(s)
- H N Sallam
- Alexandria University, Egypt, Obstetrics and Gynaecology, 22 Victor Emanuel Square, Smouha, Alexandria, Egypt, 21615.
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Wong BC, Gillman NC, Oehninger S, Gibbons WE, Stadtmauer LA. Results of in vitro fertilization in patients with endometriomas: is surgical removal beneficial? Am J Obstet Gynecol 2004; 191:597-606; discussion 606-7. [PMID: 15343246 DOI: 10.1016/j.ajog.2004.05.079] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the effect of endometriomas on clinical pregnancy rates of in vitro fertilization-embryo transfer. STUDY DESIGN Infertile patients with endometriosis who underwent in vitro fertilization-embryo transfer were divided into group 1 patients who had a history of ovarian endometriomas and group 2 patients who did not. The patients in group 1 were further divided into group 1A who had their endometriomas removed by laparoscopic ovarian cystectomy before the start of in vitro fertilization-embryo transfer and group 1B who underwent in vitro fertilization-embryo transfer with the presence of endometriomas. The clinical pregnancy rates of these groups were compared. RESULTS Clinical pregnancy rates per transfer were similar in group 1 and group 2 (40% vs 47%; P =.38) and similar in patients in group 1A and group 1B (47% vs 34%; P =.28), although the direction was toward improved pregnancy rates in the groups of patients without endometriomas present at the time of in vitro fertilization stimulation. When patients >39 years of age were excluded, the overall pregnancy rate was higher in those patients who had no current endometriomas than in those patients who had endometriomas present at the time of stimulation (65% vs 39%; P =.05). For patients with unilateral endometriomas, similar numbers of mature oocytes were aspirated between the affected and unaffected ovaries. CONCLUSION Although the history of endometriomas does not appear to affect in vitro fertilization-embryo transfer outcomes adversely, there may be a benefit in the removal of endometriomas before in vitro fertilization.
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Affiliation(s)
- Benjamin C Wong
- Department of Obstetrics and Gynecology, The Howard and Georgeanna Jones Institute for Reproductive Medicine, Eastern Virginia Medical School, 601 Colley Avenue, Norfolk, VA 23507, USA
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Zikopoulos K, Kolibianakis EM, Devroey P. Ovarian stimulation for in vitro
fertilization in patients with endometriosis. Acta Obstet Gynecol Scand 2004; 83:651-5. [PMID: 15225190 DOI: 10.1111/j.0001-6349.2004.00543.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The use of gonadotropin-releasing hormone (GnRH) agonists in a long protocol appears to enhance the probability of conception in the presence of endometriosis. In addition, there is evidence to suggest that the use of prolonged downregulation with GnRH agonists prior to ovarian stimulation for in vitro fertilization (IVF) is beneficial for achieving pregnancy. Until now, GnRH antagonists have not been used in patients with endometriosis. The management of endometriomas prior to stimulation for IVF and its impact on reproductive outcome are still subject to debate.
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Affiliation(s)
- Kostantinos Zikopoulos
- Center for Reproductive Medicine, Dutch-Speaking Brussels Free University, Brussels, Belgium
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Abstract
OBJECTIVE To review the literature on the use of medical management of endometriosis and infertility. DESIGN Literature review. RESULT(S) Endometriosis is a common finding in women with infertility, but the mechanism by which it renders a woman infertile remains unclear. Despite many years of controversy and debate, there remains a strong bias against medical treatment for endometriosis-associated infertility. A review of the current literature suggests that medical management of endometriosis may be effective in selected patients and in certain settings, including patients undergoing IVF. CONCLUSION(S) A closer look at the question of medical management of endometriosis reveals that much remains to be learned before a final decision can be made about the use of medical therapies, such as GnRH agonists, for endometriosis and associated infertility.
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Affiliation(s)
- B A Lessey
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics-Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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9
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Abstract
The association between endometriosis and infertility is well established, and different mechanisms have been postulated to cause infertility depending on the stage of endometriosis. Controlled ovarian hyperstimulation improves pregnancy outcome for minimal to mild endometriosis; however, there are no randomized controlled studies of this technique in patients with severe disease. Further, ART appears to have an overall beneficial effect for all stages of endometriosis. Based on the current staging system, several studies have not been able to demonstrate a significant difference in true outcomes for different stages of the disease. The limitations of these studies have been discussed above. Similarly, the effect of endometriomas when considered independent of the stage is still unclear. In addition to ART, pretreatment with GnRH analogues or surgical intervention may be beneficial and needs to be addressed in randomized controlled studies. It is evident that we urgently need large randomized studies to answer several questions about the treatment of endometriosis-associated infertility with ART. Although our current practice is based primarily on retrospective observational studies and small randomized studies, the overall impact on pregnancy outcome is beneficial.
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Affiliation(s)
- A Dokras
- Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, CT 06510, USA
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10
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Huang HY, Lee CL, Lai YM, Chang MY, Chang SY, Soong YK. The outcome of in vitro fertilization and embryo transfer therapy in women with endometriosis failing to conceive after laparoscopic conservative surgery. THE JOURNAL OF THE AMERICAN ASSOCIATION OF GYNECOLOGIC LAPAROSCOPISTS 1997; 4:299-303. [PMID: 9154777 DOI: 10.1016/s1074-3804(05)80219-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
STUDY OBJECTIVE To compare the outcome of in vitro fertilization and embryo transfer (IVF-ET) after laparoscopic surgery in women with endometriosis with that of patients with tubal factor infertility. DESIGN Retrospective survey of hospital and office charts using a computerized worksheet. SETTING Lin-Kou medical center of Chang Gung Memorial Hospital. PATIENTS Sixty-seven women with minimal to mild or moderate to severe endometriosis. Women with tubal factor infertility without other associated disorders (60 cycles) made up the control group. INTERVENTIONS Seventy-five consecutive cycles of IVF-ET were performed in these patients who failed to conceive after laparoscopic conservative surgery. MEASUREMENTS AND MAIN RESULTS The concentration of serum estradiol on the day of human chorionic gonadotropin (hCG) injection, the day of hCG injection, clinical pregnancy rates per transfer, number of follicles larger than 14 mm, number of embryos transferred, and implantation rate were not significantly different between women with endometriosis and those with tubal factor infertility. The number of oocytes retrieved and number fertilized were decreased, and the basal level of follicle-stimulating hormone on cycle day 3 was higher in women with both degrees of endometriosis. Women in both endometriosis groups received more follicle-stimulating hormone and human menopausal gonadotropin than those with tubal factor infertility. CONCLUSIONS The outcome of IVF-ET in patients with endometriosis after laparoscopic surgery did not differ from that in the group with tubal factor infertility, but the former required more ampules of gonadotropin to achieve the same response. The advantages of laparoscopic surgery in women with endometriosis should be probably correlated with success of IVF-ET.
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Affiliation(s)
- H Y Huang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chang Gung Medical College 5, Fu-Hsing Street, Kwei-Shan, Tao-Yuan, Taiwan, Republic of China
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Plosker GL, Brogden RN. Leuprorelin. A review of its pharmacology and therapeutic use in prostatic cancer, endometriosis and other sex hormone-related disorders. Drugs 1994; 48:930-67. [PMID: 7533699 DOI: 10.2165/00003495-199448060-00008] [Citation(s) in RCA: 112] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Leuprorelin (leuprolide acetate) is a gonadotrophin-releasing hormone (GnRH) analogue used to treat a wide range of sex hormone-related disorders including advanced prostatic cancer, endometriosis and precocious puberty. It acts primarily on the anterior pituitary, inducing a transient early rise in gonadotrophin release. With continued use, leuprorelin causes pituitary desensitisation and/or down-regulation, leading to suppressed circulating levels of gonadotrophins and sex hormones. Clinical trials in men with advanced prostatic cancer demonstrate that leuprorelin (usually monthly depot injections of 3.75 or 7.5 mg) is less likely to cause serious adverse cardiovascular effects than diethylstilbestrol, and has comparable efficacy to bilateral orchiectomy or other GnRH analogues. Therefore, the choice between leuprorelin and orchiectomy may be made on the basis of the patient's treatment preference, along with specific patient characteristics and cost implications. Monthly intramuscular or subcutaneous administration of depot leuprorelin 3.75 mg was superior to placebo, and comparable to oral danazol 800 mg/day or intranasal buserelin 900 micrograms/day, in achieving objective and subjective responses in women with endometriosis. Thus, leuprorelin is an effective alternative to other treatments for women with endometriosis, but the recommended duration of its use in this clinical setting is limited to 6 months because it reduces bone mineral density. In children with central precocious puberty, leuprorelin (usually monthly intramuscular or subcutaneous injections of depot leuprorelin 3.75 to 15mg) decreases mean growth velocity and signs of sexual maturation and increases predicted adult height compared with baseline measurements. Although effects on final adult height are predicted from available data and require confirmation in long term follow-up studies, the absence of effective alternatives to GnRH analogues makes leuprorelin a first-line therapy for children with this rare disease. In women with uterine leiomyomata, monthly intramuscular administration of depot leuprorelin 3.75 mg for 6 months markedly reduces uterine volume and fibroid-related symptoms, but, as with other GnRH analogues, these effects dissipate following discontinuation of the drug. As adjuvant therapy in women undergoing in vitro fertilisation or gamete intrafallopian transfer, leuprorelin (usually 0.5 to 1 mg/day subcutaneously) reduces the risk of cancelled cycles for oocyte retrieval by preventing premature luteinisation. While some studies demonstrate an improvement in intermediate end-points such as increased number of mature oocytes retrieved and embryos available for transfer, a significant effect has not been demonstrated on the rate of live births per stimulated cycle.(ABSTRACT TRUNCATED AT 400 WORDS)
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Affiliation(s)
- G L Plosker
- Adis International Limited, Auckland, New Zealand
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Gordon K, Scott RT, Williams RF, Danforth DR, Loozen HJ, Kloosterboer HJ, Hodgen GD. In vivo effects of a potent GnRH antagonist ORG 30850: physiologic evidence that down-regulation of GnRH receptors does not occur. JOURNAL OF THE SOCIETY FOR GYNECOLOGIC INVESTIGATION 1994; 1:290-6. [PMID: 9419786 DOI: 10.1177/107155769400100408] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Our purpose was to determine the pituitary responsiveness to exogenous GnRH in GnRH antagonist-suppressed ovariectomized monkeys. METHODS This was a prospective experimental non-human primate study performed at the research laboratories of The Jones Institute for Reproductive Medicine. Seventeen long-term ovariectomized cynomolgus monkeys were studied. INTERVENTIONS The GnRH antagonist ORG 30850 was administered to long-term ovariectomized monkeys assigned to one of six groups: single subcutaneous injections in group A (n = 4), 0.3 mg/kg; group B (n = 4), 1.0 mg/kg; and group C (n = 3), 3.0 mg/kg; and six consecutive daily subcutaneous injections in group D (n = 2), 0.3 mg/kg; group E (n = 2), 1.0 mg/kg; and group F (n = 2), 3.0 mg/kg. Blood samples were collected daily from 10 days before treatment until 22 days after treatment, then weekly for 6 additional weeks. Intravenous GnRH stimulation tests (10 micrograms/kg) were performed on the day after vehicle injection (control) and the day after completion of treatment(s), and then at weekly intervals. The main outcome measures were serum levels of LH, FSH, and ORG 30850. RESULTS Administration of ORG 30850 resulted in suppression (P < .05) of LH and FSH in all treatment groups. Long-term suppression (greater than 2 weeks) was evident in all primates receiving a cumulative dose of at least 1 mg/kg. Paradoxically, the responsiveness of the pituitary to exogenous GnRH was accentuated during the time of maximal tonic LH/FSH suppression. CONCLUSIONS ORG 30850 is a potent long-acting GnRH antagonist. Furthermore, the present in vivo demonstration of heightened pituitary responsiveness to exogenous GnRH emphasizes the divergent mechanisms of action of GnRH antagonists and GnRH agonists.
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Affiliation(s)
- K Gordon
- Department of Obstetrics and Gynecology, Jones Institute for Reproductive Medicine, Eastern Virginia Medical School, Norfolk 23507, USA
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Curtis P, Jackson A, Bernard A, Shaw RW. Pretreatment with gonadotrophin releasing hormone (GnRH) analogue prior to in vitro fertilisation for patients with endometriosis. Eur J Obstet Gynecol Reprod Biol 1993; 52:211-6. [PMID: 8163038 DOI: 10.1016/0028-2243(93)90074-m] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
To assess the effect of GnRH pretreatment prior to IVF-ET on fertilisation and pregnancy rates in patients with endometriosis compared with tubal infertility, a retrospective analysis of 228 cycles of tubal infertility cases (Group 1) and 92 cycles of endometriosis has been performed. Patients with endometriosis were classified by the revised AFS scoring system to two groups: 37 cycles of minimal and mild endometriosis (Group 2) and 55 cycles of moderate and severe endometriosis (Group 3). The GnRH analogue buserelin was used for pituitary desensitisation in all IVF cycles. Endometriosis patients have a minimum of 6 weeks GnRH treatment prior to superovulation therapy. Although the fertilisation rate per oocyte (51%) was significantly lower in Group 3 (P < 0.001), the percentage of cycles in which fertilisation occurred (86%, 78%, 78%) and the pregnancy rates per embryo transfer (17.7%, 17.2%, 18.6%) for Groups 1, 2 and 3, respectively, were not significantly different. Pretreatment with GnRH analogues allows patients with endometriosis to achieve similar success rates to patients with tubal infertility alone.
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Affiliation(s)
- P Curtis
- University Department of Obstetrics and Gynaecology, Royal Free Hospital School of Medicine, Hampstead, London, UK
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Nakamura K, Oosawa M, Kondou I, Inagaki S, Shibata H, Narita O, Suganuma N, Tomoda Y. Menotropin stimulation after prolonged gonadotropin releasing hormone agonist pretreatment for in vitro fertilization in patients with endometriosis. J Assist Reprod Genet 1992; 9:113-7. [PMID: 1627925 DOI: 10.1007/bf01203749] [Citation(s) in RCA: 53] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Two protocols were scheduled for in vitro fertilization and embryo transfer (IVF-ET) in patients with various stages of endometriosis who were resistant to conventional therapies. In the ultralong protocol (21 patients), gonadotropin releasing hormone agonist (Gn-RHa) was administered for at least 60 days prior to ovarian stimulation along with menotropin until human chorionic gonadotropin was injected. In the long protocol (11 patients), Gn-RHa was started at the midluteal phase and exogenous gonadotropin was commenced between the third and the seventh day of the menstrual cycle after pituitary suppression. The estradiol response and the number of retrieved oocytes, fertilized oocytes, cleaved oocytes, and transferred embryos were similar in both groups but the clinical pregnancy rate per transfer was superior in the ultralong protocol (67 vs 27%). The miscarriage rate was 14% (2/14) in the ultralong protocol. Prolonged Gn-RHa suppression of ovarian function before superovulation may overcome some causes of infertility in patients with endometriosis.
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Affiliation(s)
- K Nakamura
- Department of Obstetrics and Gynecology, Branch Hospital, Nagoya University, Japan
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15
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Oehninger S, Hodgen GD. Induction of ovulation for assisted reproduction programmes. BAILLIERE'S CLINICAL OBSTETRICS AND GYNAECOLOGY 1990; 4:541-73. [PMID: 2282742 DOI: 10.1016/s0950-3552(05)80310-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The decision to use enhancement of the natural ovarian/menstrual cycle to attempt collection of several oocytes during IVF and GIFT cycles has dramatically increased the pregnancy rates. Furthermore, the recovery of multiple fertilizable oocytes allows for cryopreservation of extra or surplus pre-embryos (or embryos), with the consequent reduction in the risk of multiple pregnancies and the improvement of the cumulative pregnancy rate following IVF and GIFT cycles. Here, we have reviewed the underlying physiological mechanisms in the natural ovarian-menstrual cycle. Subsequently, we have analysed the more frequently utilized ovarian stimulatory regimens with special emphasis on the use of gonadotrophins. Several conclusions may be drawn from the experience to date with these methods of ovarian stimulation. Primarily, lower doses of medication, when used appropriately, may result in a more favourable outcome. Most significant, it seems to be beneficial to tailor the dosages and timing of drug administration to the patient's individual response to medication. Because ovarian stimulation therapy is difficult to manage, a major challenge in reproductive endocrinology has been to develop stimulation protocols that would 'ideally' synchronize the development of a cohort of follicles. The development of GnRH analogues (agonists and antagonists) and the experience (both in women and macaques) gained so far when these drugs are used in combination with gonadotrophins, have helped both in the understanding of the underlying physiology and in the improvement of clinical results.
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Jequier AM, Cummins JM, Gearon C, Apted SL, Yovich JM, Yovich JL. A pregnancy achieved using sperm from the epididymal caput in idiopathic obstructive azoospermia. Fertil Steril 1990; 53:1104-5. [PMID: 2351233 DOI: 10.1016/s0015-0282(16)53597-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- A M Jequier
- PIVET Medical Centre, Leederville, Perth, Western Australia
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