scholarly journals Evaluation of GnRH antagonist pretreatment before ovarian stimulation in a GnRH antagonist protocol in normal ovulatory women undergoing IVF/ICSI: a randomized controlled trial

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Yisheng Zhang ◽  
Liling Liu ◽  
Jie Qin ◽  
Hongyi Huang ◽  
Lintao Xue ◽  
...  
Keyword(s):  
Pregnancy Rate ◽  
Live Birth ◽  
Pregnancy Outcomes ◽  
Birth Rate ◽  
Gnrh Antagonist ◽  
Live Birth Rate ◽  
Controlled Study ◽  
Randomized Controlled ◽  
Gnrh Antagonist Protocol ◽  
Antagonist Protocol

Abstract Background Synchronization of follicles is key to improving ovulation stimulation with the gonadotropin-releasing hormone (GnRH) antagonist protocol. GnRH antagonist administration in the early follicular phase can quickly decrease gonadotrophin (Gn) levels and achieve downregulation before stimulation, which may improves synchronization. A previous small randomized controlled study (RCT) showed that pretreatment with a GnRH antagonist for 3 days before stimulation may increase oocyte retrieval but cannot increase the pregnancy rate. This study investigated whether the GnRH antagonist pretreatment protocol in ovulatory women can increase the synchronization of follicles and pregnancy outcomes compared with the conventional GnRH antagonist protocol. Methods This RCT included 136 normal ovulatory women undergoing in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI). Both groups were treated with recombinant follicle-stimulating hormone (r-FSH) and a flexible GnRH antagonist protocol. The women were randomized into two equal groups with or without GnRH antagonist administration from day 2 of the menstrual cycle for 3 days before stimulation. Our primary outcome was the number of retrieved oocytes. Secondary outcomes included the pregnancy rate and live birth rate. Results Both groups had similar baseline characteristics. The number of retrieved oocytes in the study group was comparable to that in the control group (9.5 [8.0–13.0] vs. 11.0 [7.0–14.8], P = 0.469). There was no significant difference in the follicle size. The fertilization rate, number of good-quality embryos, implantation rate, pregnancy rate, ongoing pregnancy rate, live birth rate per embryonic transfer cycle, and miscarriage rate were similar between the two groups. Conclusion This large RCT analysed GnRH antagonist pretreatment with the GnRH antagonist protocol applied to normal ovulatory women undergoing IVF/ICSI. The number of retrieved oocytes and pregnancy outcomes did not significantly vary. Trial registration Chinese Clinical Trial Registry, ChiCTR1800019730. Registered 26 November 2018.

scholarly journals Evaluation of GnRH antagonist pre-treatment before ovarian stimulation in a delayed-start antagonist protocol in normal ovulatory women undergoing IVF/ICSI: a randomized controlled trial (RCT)

2021 ◽  
Author(s):  
Yisheng Zhang ◽  
Liling Liu ◽  
Jie Qin ◽  
Hongyi Huang ◽  
Lintao Xue ◽  
...  
Keyword(s):  
Pregnancy Rate ◽  
Live Birth ◽  
Pregnancy Outcomes ◽  
Gnrh Antagonist ◽  
Controlled Trial ◽  
Statistical Significance ◽  
Control Group ◽  
Gnrh Antagonist Protocol ◽  
Pre Treatment ◽  
Antagonist Protocol

Abstract Background: Synchronization of follicles is key to improving ovulation stimulation with the GnRH antagonist protocol. GnRH antagonist administration in the early follicular phase can quickly decrease gonadotrophin (Gn) levels and achieve downregulation before stimulation, which improves synchronization. A small RCT showed that pre-treatment with a GnRH antagonist for three days before stimulation might increase oocyte retrieval but cannot increase the pregnancy rate. This study investigated whether the "delayed-start" protocol in ovulatory women can increase the synchronization of follicles and pregnancy outcomes compared with the conventional GnRH antagonist protocol.Methods: This RCT included 136 normal ovulatory women undergoing IVF/ICSI. Both groups were treated with recombinant FSH (r-FSH) and a flexible GnRH antagonist protocol. The women were randomized into two equal groups with or without GnRH antagonist from day 2 of the menstrual cycle. Our primary outcome was the number of oocytes retrieved. Secondary outcomes included the pregnancy and live birth rates.Results: Both groups had similar baseline characteristics. The number of oocytes retrieved in the study group was comparable to that in the control group (9.5(8.0-13.0) vs. 11.0(7.0-14.8),P=0.469). There was no statistical significance among the follicular size differences. The fertilization rate, number of good-quality embryos, implantation rate, pregnancy rate, ongoing pregnancy rate, live birth rate per ET cycle, and miscarriage rate were all similar between the two groups.Conclusion: This large RCT analysed the "delayed-start" GnRH antagonist protocol applied to normal ovulatory women performing IVF/ICSI. The number of oocytes retrieved and pregnancy outcomes did not vary significantly. Future trials need to confirm these findings.Trial registration: Chinese Clinical Trial Registry, ChiCTR1800019730. Registered 26 November 2018,http://www.chictr.org.cn/showproj.aspx?proj=29969.

scholarly journals Cumulative Live Birth Rates in Patients with Polycystic Ovary Syndrome: Comparing Progestin Primed Ovarian Stimulation Protocol and GnRH-Antagonist Protocol

2020 ◽  
Author(s):  
Jingjuan Ji ◽  
Lihua Luo ◽  
Lingli Huang
Keyword(s):  
Embryo Transfer ◽  
Live Birth ◽  
Ovarian Stimulation ◽  
Birth Rate ◽  
Gnrh Antagonist ◽  
Polycystic Ovary ◽  
Live Birth Rate ◽  
Cumulative Live Birth ◽  
Gnrh Antagonist Protocol ◽  
Antagonist Protocol

Abstract Background: Cumulative live birth rate (CLBR) becomes a comprehensive and meaningful indictor of the success of IVF nowadays. Frozen-embryo transfer (FET) was associated with a higher rate of live birth and a lower risk of the ovarian hyperstimulation syndrome (OHSS) in polycystic ovary syndrome (PCOS) patients. Progestin-primed ovarian stimulation (PPOS) is a new ovarian stimulation protocol in which oral progestin been used to prevent premature luteinizing hormone (LH) surges during ovarian stimulation. The purpose of the current study is to investigate the CLBR of an in vitro fertilization (IVF) cycle in women with PCOS following PPOS protocol compared with gonadotropin releasing hormone (GnRH) antagonist protocol.Methods: It is a retrospective study. The first IVF cycle of 666 PCOS women were included. Ovarian stimulations were performed with PPOS or GnRH antagonist protocol. All patients included in the analysis had either delivered a baby or had used all their embryos of their first stimulated cycle. The patients were followed for 2–7 years until February 2020.Result(s): The CLBR were similar in the PPOS and GnRH antagonist group (64% vs 60.1%, P = 0.748). Logistic regression analyses showed treatment protocol (PPOS vs GnRH antagonist) did not show any significant correlation with the CLBR (adjusted OR: 0.898; 95% CI: 0.583-1.384, P=0.627). No statistically significant differences were found in the live birth rates per embryo transfer (41.3% vs. 38.4%) in the study group and controls.Conclusion(s): The results of this study showed that both the live birth rate per embryo transfer and the cumulative live birth rate were similar between PPOS and GnRH antagonist group. PPOS protocol is efficient in the controlled ovarian stimulation of patients with PCOS.

scholarly journals Low Serum LH Levels During Ovarian Stimulation With GnRH Antagonist Protocol Decrease the Live Birth Rate After Fresh Embryo Transfers but Have No Impact in Freeze-All Cycles

2021 ◽  
Vol 12 ◽  
Author(s):  
Yiyang Luo ◽  
Shan Liu ◽  
Hui Su ◽  
Lin Hua ◽  
Haiying Ren ◽  
...  
Keyword(s):  
Embryo Transfer ◽  
Live Birth ◽  
Birth Rate ◽  
Gnrh Antagonist ◽  
Outcome Measure ◽  
Live Birth Rate ◽  
Serum Lh ◽  
Fresh Frozen ◽  
Gnrh Antagonist Protocol ◽  
Antagonist Protocol

ObjectiveTo explore the association between serum LH levels and the cumulative live birth rate (CLBR) within one complete cycle, and the impact of serum LH levels on the live birth rate (LBR) after the initial embryo transfer (ET) considering different ET strategies (fresh or freeze-all).DesignA retrospective cohort study.SettingUniversity-affiliated reproductive center.Patients1480 normogonadotrophic women who underwent COS with GnRH antagonist protocol for the first IVF/ICSI attempt.Intervention(s)The sample was stratified into low and higher LH groups according to serum LH peak levels of <4 (Group A) and ≥4 IU/L (Group B) during COS. Patients were also sub-grouped into conventional fresh/frozen ET cycles and freeze-all cycles.Main outcome measure(s)The LBR after the initial embryo transfer and the CLBR within one complete cycle.Secondary outcome measure(s)The numbers of day-3 high-quality embryos, the numbers of embryos available, and the other pregnancy outcomes after the initial ET.Result(s)In the whole cohort, the CLBRs decreased significantly in the low (63.1% vs. 68.3%, P=.034) LH group compared to the higher LH group. Subgroup analysis revealed that patients with low LH levels had lower LBR after fresh ET (38.0% vs. 51.5%, P=.005) but comparable LBR after the first frozen-thawed ET (FET) in freeze-all cycles (49.8% vs. 51.8%, P=.517) than patients with higher LH peak levels. Likewise, patients with low LH levels had lower CLBR for conventional fresh/frozen ET cycles (54.8% vs. 66.1%, P=.015) but comparable CLBR for the freeze-all cycles (66.8% vs. 69.2%, P=.414) than those with higher LH levels. Following confounder adjustment, multivariable regression analyses showed that low LH level was an independent risk factor for the CLBR in the whole cohort (odds ratio (OR): 0.756, 95% confidence interval (CI): 0.604-0.965, P=.014) and in patients who underwent the conventional ET strategy (OR: 0.596, 95% CI: 0.408-0.917, P=.017). Moreover, the adverse impact of low LH levels on LBRs maintained statistically significant after fresh transfers (OR: 0.532, 95% CI: 0.353-0.800, P=.002) but not after the first FETs in freeze-all cycles (OR: 0.918, 95% CI: 0.711-1.183, P=.508).Conclusion(s)In comparison with higher LH levels, low LH levels decrease the CLBRs per oocyte retrieval cycle for normogonadotrophic women who underwent COS using GnRH antagonists. This discrepancy may arise due to the significant detrimental effect of low LH levels on the LBRs after fresh embryo transfers.

scholarly journals Randomized Controlled Study of the Effects of DHEA on the Outcome of IVF in Endometriosis

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Yanxia Zhang ◽  
Meiqing Li ◽  
Lian Li ◽  
Jianghua Xiao ◽  
Zhe Chen
Keyword(s):  
Pregnancy Rate ◽  
Live Birth ◽  
Birth Rate ◽  
Implantation Rate ◽  
Live Birth Rate ◽  
Clinical Pregnancy ◽  
Clinical Pregnancy Rate ◽  
Synthesis Process ◽  
Controlled Study ◽  
Control Group

Objective. To investigate the effect of dehydroepiandrosterone (DHEA) on the outcome of in vitro fertilization (IVF) in patients with endometriosis (EMT). Methods. Female patients diagnosed with EMT in our hospital from May 2018 to May 2019 were selected. The patients were divided into the control group (n = 22) and the DHEA group (n = 22) according to the random number table. Patients in the control group received placebo and patients in the DHEA group received DHEA. Patients in both groups received either DHEA (25 mg) or placebo orally 3 times a day for 90 days from the first day of menstruation. Patients were subsequently treated with an IVF cycle. In the control group, 22 patients completed the first cycle and 13 patients completed the second cycle. In the DHEA group, 22 patients completed the first cycle and 11 patients completed the second cycle. Serum sex hormone levels including serum E2 on hCG day, mean progesterone on hCG day, FSH on day 2, AMH on day 2, and gonadotropin dose were determined using a chemiluminescent immunoassay kit. The number of antral follicles of the bilateral ovaries was counted by transvaginal B-ultrasound, and the maximum length and transverse diameter of the ovaries were measured at the same time, to calculate the average diameter of the ovaries, observe the morphology of endometrium, and measure the thickness of the endometrium. The implantation rate, clinical pregnancy rate, persistent pregnancy rate, and live birth rate were compared between the two groups. Results. There were no significant differences in serum E2, progesterone, endometrial thickness, recovered oocytes, mean number of transferred embryos, and mean score of leading embryo transfer between the DHEA group and the women who completed the first and second cycles ( P > 0.05 ). The AMH, antral follicle count, serum E2 on hCG day, the number of recovered oocytes, fertilized oocytes, and the fertilization rate in the DHEA group were higher than those in the control group ( P < 0.05 ). The doses of FSH on day 2, COH on day 3, and gonadotropin were lower than those in the control group ( P < 0.05 ). There was no significant difference in the total number of embryos, the number of high-quality embryos, and the number of transplanted embryos between the two groups ( P > 0.05 ). The implantation rate, clinical pregnancy rate, persistent pregnancy rate, and live birth rate in the DHEA group were higher than those in the control group ( P < 0.05 ). Conclusion. DHEA can significantly increase serum E2 level and improve IVF outcome by regulating the hormone synthesis process, thus improving oocyte and embryo quality.

scholarly journals The Developmental Stage at Cryopreservation in Assisted Reproduction: A Systematic Review and Meta-Analysis of Pregnancy Outcomes

2021 ◽  
Vol 6 (1) ◽  
Keyword(s):  
Systematic Review ◽  
Pregnancy Rate ◽  
Embryo Transfer ◽  
Live Birth ◽  
Pregnancy Outcomes ◽  
Birth Rate ◽  
Developmental Stages ◽  
Meta Analysis ◽  
Live Birth Rate ◽  
Frozen Embryo Transfer

To date, there is no consensus in embryo developmental stages for cryopreservation. The present study aimed to investigate the impact of embryo developmental stages at cryopreservation on pregnancy outcomes of frozen embryo transfer. Systematic review and meta-analysis of relevant studies identified through MEDLINE literature search was performed. The primary outcome was live birth/delivery rate, and the secondary outcomes included implantation rate, ongoing pregnancy rate, clinical pregnancy rate, miscarriage rate, and multiple pregnancy rate. The protocol of this systematic review has been registered on PROSPERO 2017 (registration number: CRD42017072828). Five studies met the eligibility criteria were included in the present review. The outcomes of embryos frozen at different stages but transferred at the same stage were analyzed and compared. Embryos frozen at non-blastocyst showed a significant higher delivery/live birth rate than those cryopreserved at blastocyst (odds ratio=1.37; 95% confidence interval, 1.13-1.66) in the setting of frozen embryo transfer with blastocysts. There was only a limited number of studies with analyzable data for comparisons. The literature varied substantially in study design and methodology applied. Although a significant difference was observed toward an improved delivery/live birth rate for blastocyst transfer with embryos frozen at non-blastocyst stage, future studies are required to further corroborate this finding.

scholarly journals Cumulative live birth rate and cost-effectiveness analysis between GnRH-antagonist protocol and multiple minimal ovarian stimulation in poor responder

2020 ◽  
Author(s):  
Yuan Liu ◽  
Yu Wu
Keyword(s):  
Cost Effectiveness ◽  
Live Birth ◽  
Ovarian Stimulation ◽  
Gnrh Antagonist ◽  
Live Birth Rate ◽  
Cost Effectiveness Analysis ◽  
Cumulative Live Birth Rate ◽  
Effectiveness Analysis ◽  
Gnrh Antagonist Protocol ◽  
Antagonist Protocol

Abstract Background The overall cumulative live birth rate (CLBR) of poor ovary responders (POR) is extremely low. Minimal ovarian stimulation (MOS) suggested a relative realistic solution in ART for POR. Our study aimed to investigate whether multiple MOS strategy results in higher CLBR compared to GnRH antagonist protocol and the cost-effectiveness analysis in POR. Methods This retrospective study involved 699 patients (1058 cycles) who fulfilled the Bologna criteria in one center performed from 2010–2018. Specifically, 325 women (325 cycles) were treated with one time conventional GnRH antagonist ovarian stimulation (GnRH-antagonist). Another 374 patients (733 cycles) were treated with multiple minimal ovarian stimulations (MOS) including natural cycles. CLBR and cost-effectiveness analysis were performed comparing these two groups of women. Results GnRH- antagonist leads to more oocytes retrieved, more fertilized oocytes and more viable embryos compared to first MOS (p < 0.001) and the cumulative corresponding ones in multiple MOS (p < 0.001). For the first IVF cycle, GnRH- antagonist results in higher CLBR than MOS (12.92% versus 4.54%, Adjusted OR 2.606; 95%CI 1.386, 4.899, p = 0.003). However, GnRH-antagonist induces comparable CLBR with multiple MOS (12.92% versus 7.92%, Adjusted OR 1.702; 95%CI 0.971, 2.982, p = 0.063), but absolutely shorter time to live birth (9 (8, 10.75) months versus 11 (9, 14) months, p = 0.014) and similar financial expenditure compared to repeated MOS (20838 (17953, 23422) ¥ versus 21261.5 (15892.5, 35140.25) ¥, p = 0.13). Conclusion Both MOS and GnRH-antagonist provide low chance of live birth for poor responders. GnRH antagonist protocol is a sound choice for POR with comparable CLBR, shorter time to live birth and similar financial expenditure.

scholarly journals GnRH agonist and hCG (dual trigger) versus hCG trigger for follicular maturation: a systematic review and meta-analysis of randomized trials

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Kai-Lun Hu ◽  
Siwen Wang ◽  
Xiaohang Ye ◽  
Dan Zhang ◽  
Sarah Hunt
Keyword(s):  
Systematic Review ◽  
Pregnancy Rate ◽  
Live Birth ◽  
Gnrh Agonist ◽  
Birth Rate ◽  
Randomized Trials ◽  
Meta Analysis ◽  
Live Birth Rate ◽  
Follicular Maturation ◽  
Hcg Trigger

Abstract Background Traditionally, final follicular maturation is triggered by a single bolus of human chorionic gonadotropin (hCG). This acts as a surrogate to the naturally occurring luteinizing hormone (LH) surge to induce luteinization of the granulosa cells, resumption of meiosis and final oocyte maturation. More recently, a bolus of gonadotropin-releasing hormone (GnRH) agonist in combination with hCG (dual trigger) has been suggested as an alternative regimen to achieve final follicular maturation. Methods This study was a systematic review and meta-analysis of randomized trials evaluating the effect of dual trigger versus hCG trigger for follicular maturation on pregnancy outcomes in women undergoing in vitro fertilization (IVF). The primary outcome was the live birth rate (LBR) per started cycle. Results A total of 1048 participants were included in the analysis, with 519 in the dual trigger group and 529 in the hCG trigger group. Dual trigger treatment was associated with a significantly higher LBR per started cycle compared with the hCG trigger treatment (risk ratio (RR) = 1.37 [1.07, 1.76], I2 = 0%, moderate evidence). There was a trend towards an increase in both ongoing pregnancy rate (RR = 1.34 [0.96, 1.89], I2 = 0%, low evidence) and implantation rate (RR = 1.31 [0.90, 1.91], I2 = 76%, low evidence) with dual trigger treatment compared with hCG trigger treatment. Dual trigger treatment was associated with a significant increase in clinical pregnancy rate (RR = 1.29 [1.10, 1.52], I2 = 13%, low evidence), number of oocytes collected (mean difference (MD) = 1.52 [0.59, 2.46), I2 = 53%, low evidence), number of mature oocytes collected (MD = 1.01 [0.43, 1.58], I2 = 18%, low evidence), number of fertilized oocytes (MD = 0.73 [0.16, 1.30], I2 = 7%, low evidence) and significantly more usable embryos (MD = 0.90 [0.42, 1.38], I2 = 0%, low evidence). Conclusion Dual trigger treatment with GnRH agonist and HCG is associated with an increased live birth rate compared with conventional hCG trigger. Trial registration CRD42020204452.

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