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Early gonadotropin-releasing hormone antagonist start improves follicular synchronization and pregnancy outcome as compared to the conventional antagonist protocol.

Park CW, Hwang YI, Koo HS, Kang IS, Yang KM, Song IO - Clin Exp Reprod Med (2014)

Bottom Line: To assess whether an early GnRH antagonist start leads to better follicular synchronization and an improved clinical pregnancy rate (CPR).The analysis of Cohort I showed that the number of mature oocytes retrieved was significantly higher in the early GnRH antagonist start cycles than in the conventional antagonist cycles (11.9 vs. 8.2, p=0.04).The analysis of Cohort II revealed higher but non-significant CPR/ET in the modified early GnRH antagonist start cycles (41.2%) than in the conventional antagonist cycles (30.2%), which was comparable to that of the GnRH agonist long protocol cycles (39.7%).

View Article: PubMed Central - PubMed

Affiliation: Division of Reproductive Endocrinology and Infertility, Department Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Catholic Kwandong University College of Medicine, Seoul, Korea.

ABSTRACT

Objective: To assess whether an early GnRH antagonist start leads to better follicular synchronization and an improved clinical pregnancy rate (CPR).

Methods: A retrospective cohort study. A total of 218 infertile women who underwent IVF between January 2011 and February 2013. The initial cohort (Cohort I) that underwent IVF between January 2011 and March 2012 included a total of 68 attempted IVF cycles. Thirty-four cycles were treated with the conventional GnRH antagonist protocol, and 34 cycles with an early GnRH antagonist start protocol. The second cohort (Cohort II) that underwent IVF between June 2012 and February 2013 included a total of 150 embryo-transfer (ET) cycles. Forty-three cycles were treated with the conventional GnRH antagonist protocol, 34 cycles with the modified early GnRH antagonist start protocol using highly purified human menopause gonadotropin and an addition of GnRH agonist to the luteal phase support, and 73 cycles with the GnRH agonist long protocol.

Results: The analysis of Cohort I showed that the number of mature oocytes retrieved was significantly higher in the early GnRH antagonist start cycles than in the conventional antagonist cycles (11.9 vs. 8.2, p=0.04). The analysis of Cohort II revealed higher but non-significant CPR/ET in the modified early GnRH antagonist start cycles (41.2%) than in the conventional antagonist cycles (30.2%), which was comparable to that of the GnRH agonist long protocol cycles (39.7%).

Conclusion: The modified early antagonist start protocol may improve the mature oocyte yield, possibly via enhanced follicular synchronization, while resulting in superior CPR as compared to the conventional antagonist protocol, which needs to be studied further in prospective randomized controlled trials.

No MeSH data available.


Related in: MedlinePlus

Schematic representation of each IVF protocol. (A) Conventional GnRH antagonist multi-dose flexible protocol. (B) Early GnRH antagonist start protocol with rFSH. (C) Modified early GnRH antagonist protocol using HP-HMG and GnRH agonist addition for luteal support. (D) GnRH agonist long protocol. MCD, menstrual cycle day; rFSH, recombinant FSH; hMG, human menopausal gonadotropin; OPU, oocyte pick up; ET, embryo transfer; GnRHa, GnRH agonist.
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Figure 1: Schematic representation of each IVF protocol. (A) Conventional GnRH antagonist multi-dose flexible protocol. (B) Early GnRH antagonist start protocol with rFSH. (C) Modified early GnRH antagonist protocol using HP-HMG and GnRH agonist addition for luteal support. (D) GnRH agonist long protocol. MCD, menstrual cycle day; rFSH, recombinant FSH; hMG, human menopausal gonadotropin; OPU, oocyte pick up; ET, embryo transfer; GnRHa, GnRH agonist.

Mentions: Thirty-four cycles of the second cohort underwent the modified early GnRH antagonist start protocol. Cetrotide (0.25 mg) daily was initiated from the second day of menses, and COS using rFSH was initiated the day after commencing cetrotide. The gonadotropin formula was then switched from rFSH to highly purified human menopause gonadotropin (HP-HMG, Menopur, Ferring, Malmo, Sweden) starting from stimulation day 5 to offset the presumed profound endogenous LH suppression induced by early GnRH antagonist administration. For final oocyte maturation, 250 µg of rhCG was administered when the leading follicle size was equal to or more than 18 mm. The LPS was provided by daily P4 IM injection (progesterone in oil, Watson Pharmaceuticals Inc., Parsippany, NJ, USA) starting on the day of oocyte retrieval. GnRH agonist, triptorelin (0.1 mg, Decapeptyl, Ferring) was also added for luteal support as a single dose administered three days after the embryo transfer (Figure 1).


Early gonadotropin-releasing hormone antagonist start improves follicular synchronization and pregnancy outcome as compared to the conventional antagonist protocol.

Park CW, Hwang YI, Koo HS, Kang IS, Yang KM, Song IO - Clin Exp Reprod Med (2014)

Schematic representation of each IVF protocol. (A) Conventional GnRH antagonist multi-dose flexible protocol. (B) Early GnRH antagonist start protocol with rFSH. (C) Modified early GnRH antagonist protocol using HP-HMG and GnRH agonist addition for luteal support. (D) GnRH agonist long protocol. MCD, menstrual cycle day; rFSH, recombinant FSH; hMG, human menopausal gonadotropin; OPU, oocyte pick up; ET, embryo transfer; GnRHa, GnRH agonist.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4295942&req=5

Figure 1: Schematic representation of each IVF protocol. (A) Conventional GnRH antagonist multi-dose flexible protocol. (B) Early GnRH antagonist start protocol with rFSH. (C) Modified early GnRH antagonist protocol using HP-HMG and GnRH agonist addition for luteal support. (D) GnRH agonist long protocol. MCD, menstrual cycle day; rFSH, recombinant FSH; hMG, human menopausal gonadotropin; OPU, oocyte pick up; ET, embryo transfer; GnRHa, GnRH agonist.
Mentions: Thirty-four cycles of the second cohort underwent the modified early GnRH antagonist start protocol. Cetrotide (0.25 mg) daily was initiated from the second day of menses, and COS using rFSH was initiated the day after commencing cetrotide. The gonadotropin formula was then switched from rFSH to highly purified human menopause gonadotropin (HP-HMG, Menopur, Ferring, Malmo, Sweden) starting from stimulation day 5 to offset the presumed profound endogenous LH suppression induced by early GnRH antagonist administration. For final oocyte maturation, 250 µg of rhCG was administered when the leading follicle size was equal to or more than 18 mm. The LPS was provided by daily P4 IM injection (progesterone in oil, Watson Pharmaceuticals Inc., Parsippany, NJ, USA) starting on the day of oocyte retrieval. GnRH agonist, triptorelin (0.1 mg, Decapeptyl, Ferring) was also added for luteal support as a single dose administered three days after the embryo transfer (Figure 1).

Bottom Line: To assess whether an early GnRH antagonist start leads to better follicular synchronization and an improved clinical pregnancy rate (CPR).The analysis of Cohort I showed that the number of mature oocytes retrieved was significantly higher in the early GnRH antagonist start cycles than in the conventional antagonist cycles (11.9 vs. 8.2, p=0.04).The analysis of Cohort II revealed higher but non-significant CPR/ET in the modified early GnRH antagonist start cycles (41.2%) than in the conventional antagonist cycles (30.2%), which was comparable to that of the GnRH agonist long protocol cycles (39.7%).

View Article: PubMed Central - PubMed

Affiliation: Division of Reproductive Endocrinology and Infertility, Department Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Catholic Kwandong University College of Medicine, Seoul, Korea.

ABSTRACT

Objective: To assess whether an early GnRH antagonist start leads to better follicular synchronization and an improved clinical pregnancy rate (CPR).

Methods: A retrospective cohort study. A total of 218 infertile women who underwent IVF between January 2011 and February 2013. The initial cohort (Cohort I) that underwent IVF between January 2011 and March 2012 included a total of 68 attempted IVF cycles. Thirty-four cycles were treated with the conventional GnRH antagonist protocol, and 34 cycles with an early GnRH antagonist start protocol. The second cohort (Cohort II) that underwent IVF between June 2012 and February 2013 included a total of 150 embryo-transfer (ET) cycles. Forty-three cycles were treated with the conventional GnRH antagonist protocol, 34 cycles with the modified early GnRH antagonist start protocol using highly purified human menopause gonadotropin and an addition of GnRH agonist to the luteal phase support, and 73 cycles with the GnRH agonist long protocol.

Results: The analysis of Cohort I showed that the number of mature oocytes retrieved was significantly higher in the early GnRH antagonist start cycles than in the conventional antagonist cycles (11.9 vs. 8.2, p=0.04). The analysis of Cohort II revealed higher but non-significant CPR/ET in the modified early GnRH antagonist start cycles (41.2%) than in the conventional antagonist cycles (30.2%), which was comparable to that of the GnRH agonist long protocol cycles (39.7%).

Conclusion: The modified early antagonist start protocol may improve the mature oocyte yield, possibly via enhanced follicular synchronization, while resulting in superior CPR as compared to the conventional antagonist protocol, which needs to be studied further in prospective randomized controlled trials.

No MeSH data available.


Related in: MedlinePlus