scholarly journals Patients With Deep Ovarian Suppression Following GnRH Agonist Long Protocol May Benefit From a Modified GnRH Antagonist Protocol: A Retrospective Cohort Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Shan Liu ◽  
Minghui Liu ◽  
Lingxiu Li ◽  
Huanhuan Li ◽  
Danni Qu ◽  
...  
Keyword(s):  
Pregnancy Rate ◽  
Gnrh Agonist ◽  
Gnrh Antagonist ◽  
Ongoing Pregnancy ◽  
Ovarian Suppression ◽  
Protocol Group ◽  
Cancellation Rate ◽  
Gnrh Antagonist Protocol ◽  
Antagonist Protocol ◽  
Long Protocol

ObjectiveTo verify if patients with deep ovarian suppression following gonadotropin releasing hormone (GnRH) agonist long protocol may benefit from a modified GnRH antagonist protocol based on luteinizing hormone (LH) levels.DesignRetrospective cohort study.SettingUniversity-based hospital.Patients110 patients exhibited ultra-low LH levels during ovarian stimulation using GnRH agonist long protocol.Intervention(s)As all the embryos in the first cycle were exhausted without being pregnant, these patients proposed to undergo a second cycle of ovarian stimulation. 74 of them were treated with a modified GnRH antagonist protocol based on LH levels. Other 36 patients were still stimulated following GnRH agonist long protocol.Main Outcome MeasureThe primary outcome was live birth rate (LBR). The second outcomes were biochemical pregnancy rate, clinical pregnancy rate (CPR), ongoing pregnancy rate (OPR) and cancellation rate.ResultsReproductive outcomes were much better in the modified GnRH antagonist protocol. The OPR and LBR were much higher in the GnRH antagonist protocol group than in the GnRH agonist long protocol group [odds ratio (OR) 3.82, 95% confidence interval (CI) 1.47, 10.61, P=0.018; OR 4.33, 95% CI 1.38, 13.60, P=0.008; respectively]. Meanwhile, the cancellation rate was much lower in the GnRH antagonist protocol group (OR 0.13, 95% CI 0.02, 0.72; P=0.014). Mean LH level during stimulation did not have a predictive value on live birth. However, it was independently associated with the occurrence of ongoing pregnancy (OR 2.70, 95% CI 1.25, 5.85; P=0.01). The results of sensitivity analyses were consistent with the data mentioned above. The patients got completely different and excellent clinical outcomes in their second cycles stimulated with the modified GnRH antagonist protocol.ConclusionPatients with deep ovarian suppression following GnRH agonist long protocol may benefit from a modified GnRH antagonist protocol based on LH levels.

scholarly journals Comparison of clinical outcomes between the depot gonadotrophin-releasing hormone agonist protocol and gonadotrophin-releasing hormone antagonist protocol in normal ovarian responders

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Min Xia ◽  
Jie Zheng
Keyword(s):  
Pregnancy Rate ◽  
Clinical Outcomes ◽  
Gnrh Agonist ◽  
Gnrh Antagonist ◽  
Clinical Pregnancy ◽  
Gonadotrophin Releasing Hormone ◽  
Gnrh Antagonist Protocol ◽  
Antagonist Group ◽  
Antagonist Protocol ◽  
Fresh Transfer

Abstract Background The gonadotrophin-releasing hormone (GnRH) antagonist protocol has some advantages, such as a simple method, short medication duration, and low incidence of ovarian hyperstimulation syndrome, but whether the GnRH antagonist protocol is suitable for normal ovarian responders has been controversial. We compared the clinical outcomes of fresh and frozen-thawed transfer cycles between the depot GnRH agonist protocol and GnRH antagonist protocol in normal ovarian responders. Methods Data of normal ovarian responders who underwent in vitro fertilization-embryo transfer (IVF-ET) or intracytoplasmic sperm injection-embryo transfer (ICSI-ET) between January 2017 and December 2018 in our hospital were retrospectively analysed. In this study, there were 1119 fresh transfer cycles, including 502 GnRH antagonist cycles (GnRH antagonist group) and 617 depot GnRH agonist cycles (depot GnRH agonist group), as well as 468 frozen-thawed transfer cycles, includng 191 GnRH antagonist cycles (GnRH antagonist group) and 277 depot GnRH agonist cycles (depot GnRH agonist group). The clinical outcomes were compared between the GnRH antagonist group and the depot GnRH agonist group. Results With the fresh transfer cycles, there were no statistically significant differences in the anti-Mullerian hormone level, number of transferred embryos or high-quality embryo rate between the two groups. The total dosage of gonadotropin (Gn), duration of Gn stimulation, number of oocytes retrieved, clinical pregnancy rate and incidences of moderate and severe ovarian hyperstimulation syndrome (OHSS) were significantly lower but the abortion rate was significantly higher in the GnRH antagonist group than in the depot GnRH agonist group (all P < 0.05). With the frozen-thawed transfer cycles, there were no statistically significant differences in the number of transferred embryos, clinical pregnancy rate or abortion rate between the two groups (all P > 0.05). Conclusions With the fresh transfer cycles, the GnRH antagonist protocol had a lower clinical pregnancy rate and lower incidences of moderate and severe OHSS than the depot GnRH agonist protocol, but with the frozen-thawed transfer cycles, both protocols had similar clinical pregnancy rates. These results remain to be further confirmed through large-sample, prospective, randomized and controlled studies.

scholarly journals A Luteinizing Hormone-based Protocol Versus Traditional Flexible Gonadotropin-Releasing Hormone Antagonist Protocol in Women with Normal Ovarian Response: Study Protocol for a non-Inferiority Trial

2021 ◽  
Author(s):  
Ya-su Lv ◽  
Yuan Li ◽  
Shan Liu
Keyword(s):  
Luteinizing Hormone ◽  
Pregnancy Rate ◽  
Ovarian Stimulation ◽  
Gnrh Antagonist ◽  
Ovarian Response ◽  
Gonadotropin Releasing Hormone ◽  
Ongoing Pregnancy ◽  
Ongoing Pregnancy Rate ◽  
Gnrh Antagonist Protocol ◽  
Antagonist Protocol

Abstract BackgroundUse of gonadotropin-releasing hormone (GnRH) antagonists during the late follicular phase can prevent premature luteinizing hormone (LH) surge. Many patients demonstrate an insufficient endogenous LH concentration during ovarian stimulation. Previous studies have demonstrated that ultra-low LH concentration influences pregnancy outcomes. However, affected patients cannot be distinguished prior to ovarian stimulation using baseline characteristics alone. With traditional fixed or flexible GnRH antagonist protocols, antagonist administration may further reduce LH activity. Previously, we proved that LH can be used as an indicator for the timing and dosage of antagonist. Patients with a persistently low LH concentration during ovarian stimulation may not require antagonists, whereas antagonist administration can affect reproductive outcomes. To further explore this hypothesis, we designed a randomized clinical trial to compare the LH-based flexible GnRH antagonist protocol with traditional flexible GnRH antagonist protocol in women with normal ovarian response. MethodsThis study was a multicenter, parallel, prospective, randomized, non-inferiority study. The primary efficacy endpoint was cumulative ongoing pregnancy rate per cycle. The study aimed to prove the non-inferiority of cumulative ongoing pregnancy rate per cycle with a LH-based flexible GnRH antagonist protocol versus traditional flexible GnRH antagonist protocol. Secondary endpoints were the high-quality embryo rate, clinical pregnancy rate, and cancellation rate. Differences in cost-effectiveness and adverse events were evaluated. The cumulative ongoing pregnancy rate per cycle in women with normal ovarian response was 70%. Considering that a non-inferiority threshold should retain 80% of the clinical effect of a control treatment, a minimal clinical difference of 14% (one-sided: α, 2.5%; β, 20%) and a total of 338 patients were needed. Anticipating a 10% dropout rate, the total number of patients required was 372.DiscussionThis is the first randomized controlled trial to compare the efficacy of a LH-based treatment regimen with a traditional flexible GnRH antagonist protocol during ovarian stimulation. We hypothesized no significant difference in cumulative ongoing pregnancy rate per cycle between the two protocols. Moreover, patients with insufficient endogenous LH during ovarian stimulation may benefit from LH-based GnRH antagonist protocols. The results will provide new information on when to introduce antagonists and the appropriate dosage of antagonist.Trial registration: ClinicalTrials.gov, ChiCTR1800018077. Registered on 29 August, 2018.

Comparing GnRH agonist long protocol and gnrh antagonist protocol in outcome the first cycle of ART

2009 ◽  
Vol 281 (1) ◽  
pp. 81-85 ◽  
Author(s):  
Razieh Dehghani Firouzabadi ◽  
Shahnaz Ahmadi ◽  
Homa Oskouian ◽  
Robab Davar
Keyword(s):  
Gnrh Agonist ◽  
Gnrh Antagonist ◽  
Gnrh Antagonist Protocol ◽  
Antagonist Protocol ◽  
Long Protocol

scholarly journals Microdose Flare-up Gonadotropin-releasing Hormone (GnRH) Agonist Protocol and GnRH Antagonist Protocol: Effects on In-vitro Fertilization in Patients with Poor-responder Diagnosis According to Bologna Criteria

2021 ◽  
Vol 3 (2) ◽  
pp. 1-5
Author(s):  
Gökşen Görgülü ◽  
Merve Çakır Köle ◽  
Oya Aldemir ◽  
Emre Köle ◽  
Serdar Dilbaz
Keyword(s):  
In Vitro Fertilization ◽  
Pregnancy Rate ◽  
Gnrh Agonist ◽  
Gnrh Antagonist ◽  
Gonadotropin Releasing Hormone ◽  
Clinical Pregnancy ◽  
Vitro Fertilization ◽  
Gnrh Antagonist Protocol ◽  
Antagonist Protocol

Objective: The aim of the study was to evaluate microdose flare-up Gonadotropin-Releasing Hormone (GnRH) agonist protocol and GnRH antagonist protocol with respect to their effects on in-vitro fertilization (IVF) results in patients with poor ovarian response according to the Bologna Criteria. Material Methods: This was a retrospective cohort study conducted in the Assisted Reproduction clinic of University of Health Sciences, Etlik Zübeyde Hanım Gynaecology Training and Research Hospital. A total of 645 patients who had been diagnosed as poor responders in our clinic, between 2007 and 2018, and received treatment with either microdose flare-up GnRH agonist protocol (n=250, 38.8%) or GnRH antagonist protocol (n=395, 61.2%), were included in the study. Results: The mean age of the study group was 34.5±5.5 years. Comparisons showed that IVF cycle cancellation frequency (p<0.01), third day estradiol level (p=0.04) and third day follicle stimulating hormone level (p<0.01) were significantly greater in patients who underwent the microdose flare-up protocol. In the GnRH antagonist group, the number of surviving children (p=0.01), antral follicle count (p<0.01), follicle count on day of human chorionic gonadotropin (hCG) administration (p<0.01), endometrial thickness on hCG day (p<0.01), number of oocytes collected (p<0.01), mature oocyte count (p<0.01), embryo transfer number (p<0.01) were higher compared to the microdose flare-up protocol group. The two groups were similar in terms of clinical pregnancy rate. Conclusions: In terms of clinical pregnancy rate, the IVF results of microdose flare-up and GnRH antagonist protocols are similar. Further studies are needed to reach more comprehensive results on the subject.

scholarly journals Luteinising hormone-based protocol versus traditional flexible gonadotropin-releasing hormone antagonist protocol in women with normal ovarian response: study protocol for a non-inferiority trial

BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e047974
Author(s):  
Ya-su Lv ◽  
Yuan Li ◽  
Shan Liu
Keyword(s):  
Pregnancy Rate ◽  
Ovarian Stimulation ◽  
Luteinising Hormone ◽  
Gnrh Antagonist ◽  
Ovarian Response ◽  
Gonadotropin Releasing Hormone ◽  
Ongoing Pregnancy ◽  
Ongoing Pregnancy Rate ◽  
Gnrh Antagonist Protocol ◽  
Antagonist Protocol

IntroductionMany patients demonstrate an insufficient endogenous luteinising hormone (LH) concentration during ovarian stimulation. With traditional fixed or flexible gonadotropin-releasing hormone (GnRH) antagonist protocols, antagonist administration may further reduce LH activity. Previously, we proved that LH can be used as an indicator for the timing and dosage of antagonist. Patients with a persistently low LH concentration during ovarian stimulation may not require antagonists, whereas antagonist administration can affect reproductive outcomes. To further explore this hypothesis, we designed a randomised clinical trial to compare the LH-based flexible GnRH antagonist protocol with traditional flexible GnRH antagonist protocol in women with normal ovarian response.Methods and analysisThis study was a multicentre, parallel, prospective, randomised, non-inferiority study. The primary efficacy endpoint was cumulative ongoing pregnancy rate per cycle. The study aimed to prove the non-inferiority of cumulative ongoing pregnancy rate per cycle with an LH-based flexible GnRH antagonist protocol versus traditional flexible GnRH antagonist protocol. Secondary endpoints were the high-quality embryo rate, clinical pregnancy rate and cancellation rate. Differences in cost-effectiveness and adverse events were evaluated. The cumulative ongoing pregnancy rate per cycle in women with normal ovarian response was 70%. Considering that a non-inferiority threshold should retain 80% of the clinical effect of a control treatment, a minimal clinical difference of 14% (one-sided: α, 2.5%; β, 20%) and a total of 338 patients were needed. Anticipating a 10% drop-out rate, the total number of patients required was 372.Ethics and disseminationThis trial has been approved by the Institutional Ethical Committee of Beijing Chao-Yang hospital. All participants in the trial will provide written informed consent. The study will be conducted according to the principles outlined in the Declaration of Helsinki and its amendments. Results of this study will be disseminated in peer-reviewed scientific journals.Trial registration numberChiCTR1800018077.

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