GnRH agonist versus GnRH antagonist in ovarian stimulation: the role of elevated peak serum progesterone levels

AbstractUtilizing corifollitropin alfa in GnRH antagonist (GnRHant) protocol in conjunction with GnRH agonist trigger/freeze-all strategy (corifollitropin alfa/GnRHant protocol) was reported to have satisfactory outcomes in women with polycystic ovary syndrome (PCOS). Although lessening in gonadotropin injections, GnRHant were still needed. In addition to using corifollitropin alfa, GnRHant was replaced with an oral progestin as in progestin primed ovarian stimulation (PPOS) to further reduce the injection burden in this study. We try to investigate whether this regimen (corifollitropin alfa/PPOS protocol) could effectively reduce GnRHant injections and prevent premature LH surge in PCOS patients undergoing IVF/ICSI cycles. This is a retrospective cohort study recruiting 333 women with PCOS, with body weight between 50 and 70 kg, undergoing first IVF/ICSI cycle between August 2015 and July 2018. We used corifollitropin alfa/GnRHant protocol prior to Jan 2017 (n = 160), then changed to corifollitropin alfa/PPOS protocol (n = 173). All patients received corifollitropin alfa 100 μg on menstruation day 2/3 (S1). Additional rFSH was administered daily from S8. In corifollitropin alfa/GnRHant group, cetrorelix 0.25 mg/day was administered from S5 till the trigger day. In corifollitropin alfa/PPOS group, dydrogesterone 20 mg/day was given from S1 till the trigger day. GnRH agonist was used to trigger maturation of oocyte. All good quality day 5/6 embryos were frozen, and frozen-thawed embryo transfer (FET) was performed on subsequent cycle. A comparison of clinical outcomes was made between the two protocols. The primary endpoint was the incidence of premature LH surge and none of the patients occurred. Dydrogesterone successfully replace GnRHant to block LH surge while an average of 6.8 days of GnRHant injections were needed in the corifollitropin alfa/GnRHant group. No patients suffered from ovarian hyperstimulation syndrome (OHSS). The other clinical outcomes including additional duration/dose of daily gonadotropin administration, number of oocytes retrieved, and fertilization rate were similar between the two groups. The implantation rate, clinical pregnancy rate, and live birth rate in the first FET cycle were also similar between the two groups. In women with PCOS undergoing IVF/ICSI treatment, corifollitropin alfa/PPOS protocol could minimize the injections burden with comparable outcomes to corifollitropin alfa/GnRHant protocol.

Download Full-text

Blood Ghrelin, Adiponectin and Resistin Levels During Controlled Ovarian Stimulation in IVF Cycles

Physiological Research ◽

10.33549/physiolres.933295 ◽

2016 ◽

pp. 809-814

Author(s):

K. DAFOPOULOS ◽

C. I. MESSINI ◽

G. ANIFANDIS ◽

P. GEORGOULIAS ◽

D. SOURLAS ◽

...

Keyword(s):

Embryo Transfer ◽

Gnrh Agonist ◽

Ovarian Stimulation ◽

Luteal Phase ◽

Controlled Ovarian Stimulation ◽

Recombinant Fsh ◽

Serum Progesterone ◽

Blood Samples ◽

Stimulation Period ◽

First Time

The aim of the present study was to investigate changes of blood ghrelin, adiponectin and resistin levels in IVF/ICSI-ET cycles. Twenty women were stimulated with recombinant FSH in a GnRH agonist short protocol for IVF/ICSI. Blood samples were taken on cycle day 2 before the commencement of injections, on cycle day 6 and on the days of HCG injection, oocyte pick up (OPU), embryo transfer (ET) as well as 7 and 12 days post-ET. Serum E2 levels increased during the stimulation, peaking on the HCG day and declined thereafter (p<0.001). Serum progesterone levels started to increase on the OPU day, peaking on the ET day (p<0.001) and decreased on days 7 and 12 post-ET. Plasma ghrelin remained unchanged during the whole cycle. Serum adiponectin levels remained stable during the stimulation period until the ET day and decreased on days 7 and 12 post-ET (p<0.001). Serum resistin levels increased until the ET day (p<0.05), remained unchanged on day 7 post-ET and decreased on day 12 post-ET (p<0.05). The present study shows for the first time that ghrelin levels did not change significantly during IVF/ICSI-ET cycles. Resistin levels increased during the stimulation period while adiponectin levels remained stable decreasing during the luteal phase.

Download Full-text

A Randomized Comparison of Two Ovarian Stimulation Protocols with Gonadotropin-Releasing Hormone (GnRH) Antagonist Cotreatment forin VitroFertilization Commencing Recombinant Follicle-Stimulating Hormone on Cycle Day 2 or 5 with the Standard Long GnRH Agonist Protocol

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2003-030807 ◽

2003 ◽

Vol 88 (9) ◽

pp. 4510-4510 ◽

Cited By ~ 2

Author(s):

F. J. Broekmans ◽

S. M. Weima ◽

E. R. te Velde

Keyword(s):

Gnrh Agonist ◽

Ovarian Stimulation ◽

Gnrh Antagonist ◽

Follicle Stimulating Hormone ◽

Gonadotropin Releasing Hormone ◽

Releasing Hormone ◽

Stimulating Hormone

Download Full-text

P–602 Pregnancy outcomes of progestin primed ovarian stimulation protocol, GnRH antagonist protocol and GnRH agonist protocol for young patients undergoing PGT-M

Human Reproduction ◽

10.1093/humrep/deab130.601 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Y Li ◽

W Zhao ◽

X Liang

Keyword(s):

Genetic Testing ◽

Gnrh Agonist ◽

Pregnancy Outcomes ◽

Ovarian Stimulation ◽

Gnrh Antagonist ◽

Young Patients ◽

Stimulation Protocol ◽

Preimplantation Genetic Testing ◽

Gnrh Antagonist Protocol ◽

Antagonist Protocol

Abstract Study question To investigate the pregnancy outcomes of progestin primed ovarian stimulation protocol, GnRH antagonist protocol and GnRH agonist protocol for young patients undergoing preimplantation genetic testing for monogenic gene diseases. Summary answer PPOS protocol could reduce the normal chromosome formation and further development potential of embryos, suggesting that the PPOS protocol should be used cautiously. What is known already GnRH antagonist protocol (GnRHant) and GnRH agonist protocol (GnRHa) have been used in clinic for many years as routine regimens, and their ovarian stimulation effects and pregnancy outcomes have been confirmed by a large number of literatures. As a new protocol in recent years, the reports of pregnancy outcomes of progestin primed ovarian stimulation protocol (PPOS) are inconsistent. Study design, size, duration This retrospective cohort study was performed in a reproduction center from a tertiary hospital between September 2018 and November 2020 which included 147 young patients (<35 year old) undergoing preimplantation genetic testing for monogenic gene diseases (PGT-M) after stimulated by progestin primed ovarian stimulation protocol (n = 44), GnRH antagonist protocol (n = 60) or GnRH agonist protocol (n = 43). Participants/materials, setting, methods This study included 147 young patients (<35 year old) undergoing preimplantation genetic testing for monogenic gene diseases (PGT-M) after stimulated by progestin primed ovarian stimulation protocol (PPOS, n = 44), GnRH antagonist protocol (GnRHant, n = 60) or GnRH agonist protocol (GnRHa, n = 43). The primary outcomes were normal karyotype embryo rate and live birth rate. The embryological and clinical outcomes were measured. Main results and the role of chance Basic characteristics such as infertility duration, age, and body mass index (BMI) were comparable in study groups. No significant difference was found in the number oocytes retrieved or viable embryos between the groups. Normal karyotype embryo rate of PPOS protocol was significantly lower than GnRHant and GnRHa protocol (57.6% for PPOS vs 76.0% for GnRHant vs 67.3% for GnRHa). No significant difference were found in chemical pregnancy rate (77.3% for PPOS vs 73.3% for GnRHant vs 74.4% for GnRHa) or clinical pregnancy rate (69.8% for PPOS vs 71.7% for GnRHant vs 72.5% for GnRHa). While live birth rate of PPOS protocol was significantly lower than GnRHant and GnRHa protocol ( 45.5% for PPOS vs 58.3% for GnRHant vs 72.2% for GnRHa). Limitations, reasons for caution This is a preliminary study which needs to be further confirmed by large-scale clinical studies. Wider implications of the findings: Although this is a preliminary study which needs to be further confirmed by large-scale clinical studies, the current results suggest that the application of PPOS should be cautious. Trial registration number -

Download Full-text