O-230 RCT comparing Recombinant-hcg trigger with Dual-trigger (GnRH-agonist and recombinant-hcg ) in improving clinical outcome in ICSI cycles in women with Diminished Ovarian Reserve

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
A Jindal ◽  
M Singh
Keyword(s):  
Clinical Outcome ◽  
Embryo Transfer ◽  
Gnrh Agonist ◽  
Ovarian Reserve ◽  
Gnrh Antagonist ◽  
Clinical Pregnancy ◽  
Diminished Ovarian Reserve ◽  
Study Group ◽  
Cancellation Rate ◽  
Hcg Trigger

Abstract Study question Does use of Dual-trigger (GnRH-agonist with recombinant-hcg) improve the clinical outcome in women with diminished ovarian reserve as compared to Recombinant-hcg trigger? Summary answer Yes, the use of Dual-trigger (GnRH-agonist with recombinant-hcg) improve the clinical outcome in women with diminished ovarian reserve as compared to Recombinant-hcg trigger. What is known already The population of poor responders has grown exponentially over the years and their management of ovarian stimulation remains one of the most challenging aspects. In GnRH antagonist down-regulated IVF-ICSI cycles, dual triggering for the final oocyte maturation with GnRH-a and a reduced dose of hCG improves the rate of fertilization and clinical pregnancy in women with diminished ovarian reserve. Further more, the benefit of lowered cycle cancellation rate would also enable greater percentage of patients with diminished ovarian reserve to reach the final stage of their ART treatment, thereby enhancing their chances of achieving a successful pregnancy . Study design, size, duration This RCT included GnRH antagonist ICSI cycles from 2018-2019. 82 women with diminished ovarian reserve (AMH ≤ 1.1 ng/ml and AFC ≤5) were included. The primary outcome measured was the oocyte fertilization rate, implantation rate and clinical pregnancy rate per oocyte retrieval cycle. Secondary outcome measured was embryo transfer cancellation rate and abortion rate per oocyte retrieval cycle. Participants/materials, setting, methods 82 women with diminished ovarian reserve undergoing fresh embryo transfer were included and randomly divided in two groups - Group-A (hCG trigger/control group: n = 41); and Group-B (dual trigger/study group: n = 41). Both patient groups underwent controlled ovarian stimulation using antagonist. The final oocyte maturation was triggered either by recombinant hCG (Group-A) or by a combination of recombinant hCG and GnRH-agonist (Dual trigger) (Group-B). Main results and the role of chance The dual-trigger group had significantly higher fertilization rate (62.8 vs. 37.6%), higher clinical pregnancy rate (31.4% vs. 18.1%) as compared to the recombinant-hCG trigger group. In addition, the abortion rate(12.1% vs. 21.3%) and embryo transfer cancellation rate (8.3% vs. 16.1%) were both significantly lower in the dual trigger group. The baseline characteristics for the control and the study group were similar and there was no significant difference in the patient age, serum AMH level, and cause of infertility. The total r-FSH dose, duration of stimulation, endometrial thickness, and serum hormone profile on the day of trigger were also similar between the control and the study group. The main advantage of triggering with GnRH-a is that it induces a mid-cycle FSH surge which resembles the natural ovulatory cycle hormonal changes. Study shows that in GnRH antagonist ART cycles, dual triggering with GnRH-a and hCG could significantly improve the rate of fertilization and clinical pregnancy in diminished ovarian reserve women. Furthermore, the benefit of lowered cycle cancellation rate would also enable greater percentage of patients with diminished ovarian reserve to reach the final stage of their ART treatment thereby enhancing their chance of achieving a successful pregnancy as well as reducing their mental stress. Limitations, reasons for caution The main limitation of our study is the low patient number. Triggering with GnRH-a has become a significant part of contemporary ART practice, especially in high responders, oocytes donors and oncology patients. However, more RCTs are required in order to justify the use of GnRH-agonists in poor responders in ART cycles. Wider implications of the findings Results of our study concurred with other studies of dual triggering, calls for a possible paradigm shift in ovulation-triggering agent for GnRH-antagonist cycles. Diminished ovarian reserve patients are constituting a large part of clinical ART practice and for such patients, obtaining maximum mature oocytes and good embryos is vitally important. Trial registration number not applicable

scholarly journals Comparison of hCG Versus Gonadotropin-Releasing Hormone Agonist to Induce Oocyte Maturation in Assisted Reproductive Technology Cycles: A Retrospective Study

2020 ◽  
pp. 1
Author(s):  
Gulay Beydilli Nacak ◽  
Elif Tozkır ◽  
Enis Ozkaya ◽  
Ebru Cogendez ◽  
Fatih Kaya
Keyword(s):  
Gnrh Agonist ◽  
Polycystic Ovarian Syndrome ◽  
Gnrh Antagonist ◽  
Control Group ◽  
Study Group ◽  
Ovarian Morphology ◽  
Gnrh Agonist Trigger ◽  
Ovarian Syndrome ◽  
Agonist Trigger ◽  
Hcg Trigger

<p><strong>OBJECTIVE:</strong> To compare some cycle characteristics and outcomes using a protocol consisting of a GnRH agonist trigger or hCG trigger after cotreatment with GnRH antagonist.</p><p><strong>STUDY DESIGN:</strong> Thirty-three patients under 35 years of age with polycystic ovarian syndrome, polycystic ovarian morphology, or previous high response who underwent ovulation trigger by GnRH agonist trigger and 132 patients under 35 years of age with the polycystic ovarian syndrome, polycystic ovarian morphology, or previous high response who underwent ovulation trigger by hCG for IVF treatment. Patients were non-randomly assigned to an ovarian stimulation protocol consisting of either GnRH agonist trigger after cotreatment with GnRH antagonist (study group) or hCG trigger after antagonist protocol (control group).</p><p><strong>RESULTS:</strong> The positive pregnancy test was obtained in 70 women in the control group whereas in 13 cases in the study group (p=0.161). No case in the study group needed hospitalization whereas there were 15 cases in the control group who were required to be hospitalized due to ovarian hyperstimulation related symptoms (p=0.04).</p><p><strong>CONCLUSIONS:</strong> The use of a protocol consisting of a GnRH agonist trigger after GnRH antagonist cotreatment and freeze-all strategy reduces the risk of ovarian hyperstimulation syndrome in high-risk patients undergoing IVF without affecting pregnancy rates.</p>

scholarly journals Comparison of Luteal Phase Estradiol Priming Stimulation Protocol and the Standard Antagonist Protocol in Patients With Diminished Ovarian Reserve Undergoing ICSI

2021 ◽  
Author(s):  
Sezin Erturk Aksakal ◽  
Oya Aldemir ◽  
İnci Kahyaoglu ◽  
İskender Kaplanoğlu ◽  
Serdar Dilbaz
Keyword(s):  
Embryo Transfer ◽  
Ovarian Reserve ◽  
Ovarian Stimulation ◽  
Luteal Phase ◽  
Clinical Pregnancy ◽  
Diminished Ovarian Reserve ◽  
Live Birth Rates ◽  
Protocol Group ◽  
Significant Difference ◽  
Antagonist Protocol

Abstract ObjectiveThis study aimed to compare the IVF outcomes in patients with diminished ovarian reserve stimulated with luteal phase estradiol (E2) priming protocol versus the standard antagonist protocol.MethodsThe study included 603 patients undergoing intracytoplasmic sperm injection cycles (ICSI) with the diagnosis of diminished ovarian reserve (DOR) who were stimulated with the luteal E2 priming protocol (n=181) and the standard antagonist protocol (n=422). Groups were compared in terms of demographic characteristics, ovarian stimulation results, ICSI cycle outcomes, clinical pregnancy, and live birth rates per embryo transfer. ResultsThe duration of ovarian stimulation was longer, and the total gonadotropin dose used was significantly higher (p=0.001) in the E2 priming protocol group than the antagonist protocol group. The number of embryos transferred was higher in the antagonist protocol group compared with the luteal E2 priming protocol group (0.87±0.75 vs. 0.64±0.49; p=001), but there was no statistically significant difference in terms of embryo quality (p>0.05). The cycle cancellation rate and the clinical pregnancy and live birth rates per embryo transfer were similar in both groups.ConclusionsThere was no significant difference between the ICSI outcomes of the patients diagnosed with diminished ovarian reserve stimulated with the antagonist protocol and the luteal E2 priming protocol. The antagonist protocol might be considered more advantageous because of the shorter treatment duration and lower doses of gonadotropin, and it allows more embryos to be transferred. Additional randomized controlled trials are needed to verify these findings.

scholarly journals Exploration of the value of progesterone and progesterone/estradiol ratio on the hCG trigger day in predicting pregnancy outcomes of PCOS patients undergoing IVF/ICSI: a retrospective cohort study

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Yiqing Yang ◽  
Bowen Liu ◽  
Gengxiang Wu ◽  
Jing Yang
Keyword(s):  
Pregnancy Rate ◽  
Gnrh Agonist ◽  
Gnrh Antagonist ◽  
Polycystic Ovary ◽  
Clinical Pregnancy ◽  
Clinical Pregnancy Rate ◽  
Progesterone Level ◽  
Vitro Fertilization ◽  
Hcg Trigger

Abstract Background Polycystic ovary syndrome (PCOS) is a common endocrine disorder with the disorders of estrogen(E2) and progesterone(P) secretion. The purpose of this study was to evaluate the association between the progesterone level or progesterone/estradiol(P/E2) ratio on human chorionic gonadotropin (hCG) trigger day and the outcome of in vitro fertilization in PCOS patients and explore the value of progesterone and P/E2 ratio for predicting the clinical pregnancy. Methods The clinical data of 1254 PCOS patients who satisfied the inclusion criteria were retrospectively analyzed, including baseline characteristics such as age, body mass index, basal sex hormone levels, et al., as well as ovarian stimulation data and clinic outcome. Results The number of follicles larger than 14 mm in diameter (P < 0.001) and retrieved oocytes (P < 0.001) was greater in the high progesterone group (progesterone ≥ 0.92 ng/mL). In the high P/E2 group(P/E2 ratio ≥ 0.3), the number of follicles larger than 14 mm in diameter (P < 0.001) and retrieved oocytes (P < 0.001), as well as the rate of high-quality embryos (P = 0.040) were significantly decreased. In ultralong GnRH agonist protocol, the implantation rate(P < 0.001), hCG positive rate (P < 0.001), clinical pregnancy rate (P < 0.001) and live birth rate (P < 0.001) were all significantly higher than long GnRH agonist protocol and GnRH antagonist protocol. The clinical pregnancy rate of high progesterone group was significantly lower than that of low progesterone group in ultralong GnRH agonist (P = 0.008). The progesterone level could be used as an indicator to predict the positive clinical pregnancy (long GnRH agonist: P = 0.001; ultralong GnRH agonist: P < 0.001) except in cycles using GnRH antagonist (P = 0.169). In the ultralong GnRH agonist, the value of progesterone level in the prediction of clinical pregnancy was significantly higher than that of the P/E2 ratio (P = 0.021). Conclusions In PCOS patients, the progesterone level is associated with clinical pregnancy rate while P/E2 ratio is not. In subgroup analysis using three different COS protocols, a significant association between progesterone level and clinical pregnancy rate can be observed in the long GnRH agonist protocol and ultralong GnRH agonist protocol. The progesterone level is significantly better than the P/E2 ratio in predicting the pregnancy outcome of PCOS patients, especially in ultralong GnRH agonist cycles.

scholarly journals Long-Acting GnRH Agonist Improves IVF Outcomes of Young Patients with Diminished Ovarian Reserve by Increasing Endometrial Receptivity.

2020 ◽  
Author(s):  
xuemei Liu ◽  
Hongchu Bao ◽  
Qinglan Qu ◽  
Zhenyu Guo ◽  
Wenshu Li ◽  
...  
Keyword(s):  
Gnrh Agonist ◽  
Ovarian Reserve ◽  
Ovarian Stimulation ◽  
Gnrh Antagonist ◽  
Young Patients ◽  
Follicular Phase ◽  
Endometrial Receptivity ◽  
Cancellation Rate ◽  
Long Acting ◽  
Long Protocol

Abstract Background: Up to now, there is not sufficient evidence to recommend a treatment optimizing in vitro fertilization (IVF) outcomes for diminished ovarian reserve (DOR). This study is aimed to investigate whether long-acting gonadotrophin-releasing hormone (GnRH) agonist long protocol in follicular phase could improve the IVF cycle outcomes for young patients with DOR when compared with GnRH antagonist and mild ovarian stimulation protocols. Methods: This retrospective cohort study was carried out from June 2015 to March 2019. 338 patients aged 20-40 years with DOR who underwent first IVF between were enrolled. These patients were assigned to three groups depending on the ovarian stimulation protocols. The outcome parameters of IVF were compared in each group. The demographic and reproductive characteristics were calculated by Mann-Whitney, Kruskal-Wallis or chi-square test as appropriate. We evaluated the clinical outcomes of IVF cycle between the three groups using univariate and multivariate logistic regression analyses. In addition, we evaluated the morphology and coverage of pinopode and expression of HOXA10 in endometrium during implantation window between three groups by scanning electron microscope and qRT-PCR.Results: Patients who received long-acting GnRH agonist long protocol had significantly higher clinical pregnancy rates (66.67%, 42.17% and 39.02%, respectively; P=.010 and .005), implantation rates (46.15%, 29.71%, and 28.57%, respectively; P=.041 and .025) and ongoing pregnancy rates (60.00%, 34.94%, and 36.59%, respectively; P=.018 and .004). They also had significantly higher duration of stimulation, total dose of gonadotrophins and endometrial thickness than the other two groups (P＜.001). However, serum luteinizing hormone (LH) and estradiol (E2) level on gonadotrophins initiation day, serum LH level on human chorionic gonadotropin (hCG) day, the embryos transferred cancellation rate and abnormal endometrium rate were significantly lower among women who received long-acting GnRH agonist (P＜.001). In addition, we found that long-acting GnRH agonist could improve the development of pinopode and mRNA of HOXA10 (P＜.05).Conclusions: To our knowledge, this is the first time that the benefit of long-acting GnRH agonist long protocol in follicular phase in young DOR patients has been reported. Though this novel protocol may have further suppressed response, it can increase endometrial receptivity, reduce cycle cancellation rate and improve IVF cycle clinical outcomes for these patients compared with mild stimulation and GnRH antagonist protocols.

P–464 What is the optimal ovarian stimulation (OS) protocol for women who undergo planned oocyte cryopreservation (POC)?

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
S Delattre ◽  
L Strypstein ◽  
P Drakopoulos ◽  
S Mackens ◽  
S D Rijdt ◽  
...  
Keyword(s):  
Gnrh Agonist ◽  
Ovarian Reserve ◽  
Multivariate Regression ◽  
Gnrh Antagonist ◽  
Oocyte Cryopreservation ◽  
P Value ◽  
Oocyte Yield ◽  
First Choice ◽  
Gnrh Antagonist Protocol ◽  
Antagonist Protocol

Abstract Study question When repeated cycles of OS for planned oocyte cryopreservation using a standard GnRH antagonist protocol are required, can OS protocol modifications improve oocyte yield? Summary answer Compared to repeating a standard GnRH antagonist protocol, switching to a long GnRH agonist protocol for POC results in a higher number of cryopreserved oocytes. What is known already The total number of cryopreserved oocytes is a key parameter of POC programs because of its association with livebirth. A substantial proportion of women embarking on POC will undergo repeated cycles of OS to reach their desired target number of vitrified oocytes. According to recent guidelines, the GnRH antagonist protocol with GnRH agonist triggering is considered the first choice protocol for POC, because of its safety profile and convenience. However, in women with normal ovarian reserve, the long GnRH agonist protocol results in a higher number of oocytes retrieved. Evidence regarding the optimal protocol for POC is limited. Study design, size, duration This is a single-centre, retrospective cohort study including 283 women who had a first cycle for POC using a standard GnRH antagonist protocol and who requested a second OS cycle to increase their total number of vitrified oocytes for later use. The choice of protocol for the second cycle was left at the discretion of the reproductive medicine specialist. All OS cycles took place between January 2009 and December 2019 in a tertiary referral hospital. Participants/materials, setting, methods After ovarian reserve testing, the first cycle OS was performed using rFSH or HPhMG in a GnRH antagonist protocol. For the second cycle, a GnRH antagonist protocol with or without antagonist pretreatment, or a long GnRH agonist protocol was prescribed. The primary outcome was the number of mature oocytes (MII) vitrified per cycle. Cycle characteristics were compared. Data were assessed by generalized estimating equation (GEE) regression analysis adjusting for covariates. Main results and the role of chance In total, 226 (79.9%) women had a GnRH antagonist protocol and 57 (20.1%) had a long GnRH agonist protocol in their second OS cycle for POC. Overall, mean age was 36.6±2.4 years. The median (CI) number of mature oocytes vitrified after the second OS cycle was significantly higher than that after the first cycle [8 (5–11) vs. 7 (4–10), p &lt; 0.001]. According to GEE multivariate regression, adjusting for relevant confounders, switching from a GnRH antagonist protocol in the first cycle to a long GnRH agonist protocol in the second cycle was the only significant predictor of the number of vitrified oocytes after the subsequent cycle (coefficient 1.59, CI 0.29–2.89, p-value = 0.017). Age, AFC, initial dose and type of gonadotropins did not predict the number of vitrified oocytes. None of the women developed moderate or severe OHSS. Similarly, of 174 women who underwent their first OS cycle with a standard GnRH antagonist protocol, 133 women (76.4%) had the same protocol for their second cycle and 41 women (23.6%) an additional three-day course of GnRH antagonist pretreatment. According to GEE multivariate regression, this protocol modification did not result in more mature oocytes available for vitrification (coefficient –0.25, CI –1.86–1.36, p-value = 0.76). Limitations, reasons for caution These data should be interpreted with caution because of the retrospective design and limited sample. Although more oocytes were obtained with a long GnRH agonist protocol we have no data on livebirth in women returning to use their oocytes to support the choice for a specific OS protocol for POC. Wider implications of the findings: Although oocyte yield in the context of POC is an important parameter that may be modulated by the choice of OS protocol, the ultimate outcome measure of a successful POC program is livebirth after oocyte vitrification. Future research of oocyte parameters reflecting oocyte quality is paramount. Trial registration number Not applicable

Retrospective comparison of GnRH agonist trigger with HCG trigger in GnRH antagonist cycles in anticipated high-responders

2014 ◽  
Vol 29 (5) ◽  
pp. 552-558 ◽  
Author(s):  
Adrija Kumar Datta ◽  
Abey Eapen ◽  
Heidi Birch ◽  
Anitha Kurinchi-Selvan ◽  
Gillian Lockwood
Keyword(s):  
Gnrh Agonist ◽  
Gnrh Antagonist ◽  
Retrospective Comparison ◽  
Gnrh Agonist Trigger ◽  
High Responders ◽  
Agonist Trigger ◽  
Hcg Trigger
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