scholarly journals Early Follicular Phase Human Chorionic Gonadotropin Addition May Improve the Outcomes of In Vitro Fertilization/Intracytoplasmic Sperm Injection in Patients With “Unpredictable” Poor Response to Gonadotropin-Releasing Hormone Antagonist Protocol

2021 ◽  
Vol 12 ◽  
Author(s):  
Chunhui Zhang ◽  
Fangrong Wu ◽  
Zexuan Wu ◽  
Bolan Sun ◽  
Cheng Chen ◽  
...  
Keyword(s):  
Serum Level ◽  
Gnrh Antagonist ◽  
Follicular Phase ◽  
Gonadotropin Releasing Hormone ◽  
Icsi Cycle ◽  
Early Follicular Phase ◽  
Gnrh Antagonist Protocol ◽  
Antagonist Protocol ◽  
Hcg Trigger

PurposeTo compare the effects of early and mid-late follicular phase administration of 150 IU of human chorionic gonadotropin (hCG) on gonadotropin-releasing hormone (GnRH) antagonist protocol in “unpredictable” poor ovarian response (POR) women undergoing in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) treatment.MethodsA retrospective single-center cohort study was conducted on 67 patients with “unpredictable” POR in their first IVF/ICSI cycle receiving GnRH antagonist protocol. Patients were treated with a second IVF/ICSI cycle using the same GnRH antagonist protocol with the same starting dose of recombinant follicle-stimulating hormone (rFSH) as the first cycle; a daily dose of 150 IU of hCG was administrated on either stimulation day 1 (Group A, n = 35) or day 6 (Group B, n = 32). The number of oocytes retrieved, number of usable embryos, serum level of estradiol (E2) on day of hCG trigger, and clinical pregnant outcomes were studied.ResultsThe addition of 150 IU of hCG on either the first day or sixth day of stimulation increases the serum level of E2, luteinizing hormone (LH), and hCG on the day of hCG trigger. Only the use of 150 IU of hCG on the first stimulation day improved the number of oocytes retrieved, mature of oocytes, and usable embryos, but not the addition of hCG on stimulation day 6. Implantation rate, clinical pregnancy rate, and ongoing pregnancy rate showed an increasing trend in patients receiving 150 IU of hCG in the early phase compared with mid-late phase, even thought there was no statistically significant difference.ConclusionsOur study demonstrated that adding 150 IU of hCG in subsequent GnRH antagonist cycle in “unpredictable” poor responders is associated with the improvement of response to stimulation. Furthermore, early follicular phase addition of 150 IU of hCG significantly increased the number of oocytes retrieved and usable embryos than did the mid-late addition of the same dose.

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 A Flexible Multidose GnRH Antagonist versus a Microdose Flare-Up GnRH Agonist Combined with a Flexible Multidose GnRH Antagonist Protocol in Poor Responders to IVF

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Gayem İnayet Turgay Çelik ◽  
Havva Kömür Sütçü ◽  
Yaşam Kemal Akpak ◽  
Münire Erman Akar
Keyword(s):  
Gnrh Agonist ◽  
Gnrh Antagonist ◽  
Poor Responders ◽  
Vitro Fertilization ◽  
Significant Difference ◽  
Gnrh Antagonist Protocol ◽  
Group 2 ◽  
Antagonist Protocol ◽  
Group 1

Objective. To compare the effectiveness of a flexible multidose gonadotropin-releasing hormone (GnRH) antagonist against the effectiveness of a microdose flare-up GnRH agonist combined with a flexible multidose GnRH antagonist protocol in poor responders to in vitro fertilization (IVF).Study Design. A retrospective study in Akdeniz University, Faculty of Medicine, Department of Obstetrics and Gynecology, IVF Center, for 131 poor responders in the intracytoplasmic sperm injection-embryo transfer (ICSI-ET) program between January 2006 and November 2012. The groups were compared to the patients’ characteristics, controlled ovarian stimulation (COH) results, and laboratory results.Results. Combination protocol was applied to 46 patients (group 1), and a single protocol was applied to 85 patients (group 2). In group 1, the duration of the treatment was longer and the dose of FSH was higher. The cycle cancellation rate was significantly higher in group 2 (26.1% versus 38.8%). A significant difference was not observed with respect to the number and quality of oocytes and embryos or to the number of embryos transferred. There were no statistically significant differences in the hCG positivity (9.5% versus 9.4%) or the clinical pregnancy rates (7.1% versus 10.6%).Conclusion. The combination protocol does not provide additional efficacy.

scholarly journals A Novel Nomogram for Individualized Gonadotropin Starting Dose in GnRH Antagonist Protocol

2021 ◽  
Vol 12 ◽  
Author(s):  
Yubin Li ◽  
Yuwei Duan ◽  
Xi Yuan ◽  
Bing Cai ◽  
Yanwen Xu ◽  
...  
Keyword(s):  
Regression Model ◽  
Ovarian Stimulation ◽  
Multivariate Regression ◽  
Gnrh Antagonist ◽  
Bootstrap Resampling ◽  
Multivariate Regression Model ◽  
Starting Dose ◽  
Gnrh Antagonist Protocol ◽  
Antagonist Protocol

Controlled ovarian stimulation (COS) is one of the most vital parts of in vitro fertilization-embryo transfer (IVF-ET). At present, no matter what kinds of COS protocols are used, clinicians have to face the challenge of selection of gonadotropin starting dose. Although several nomograms have been developed to calculate the appropriate gonadotropin starting dose in gonadotropin releasing hormone (GnRH) agonist protocol, no nomogram was suitable for GnRH antagonist protocol. This study aimed to develop a predictive nomogram for individualized gonadotropin starting dose in GnRH antagonist protocol. Single-center prospective cohort study was conducted, with 198 women aged 20-45 years underwent IVF/intracytoplasmic sperm injection (ICSI)-ET cycles. Blood samples were collected on the second day of the menstrual cycle. All women received ovarian stimulation using GnRH antagonist protocol. Univariate and multivariate analysis were performed to identify predictive factors of ovarian sensitivity (OS). A nomogram for gonadotropin starting dose was developed based on the multivariate regression model. Validation was performed using concordance statistics and bootstrap resampling. A multivariate regression model based on serum anti-Müllerian hormone (AMH) level, antral follicle count (AFC), and body mass index (BMI) was developed and accounted for 59% of the variability of OS. An easy-to-use predictive nomogram for gonadotropin starting dose was established with excellent accuracy. The concordance index (C-index) of the nomogram was 0.833 (95% CI, 0.829-0.837). Internal validation using bootstrap resampling further showed the good performance of the nomogram. In conclusion, gonadotropin starting dose in antagonist protocol can be predicted precisely by a novel nomogram.

scholarly journals The Early Coasting Method during Ovarian Stimulation in Antagonist Protocols with Combined Use of Cabergoline is Useful in Patients with Polycystic Ovary Syndrome

2021 ◽  
Vol 6 (3) ◽  
pp. 1-6
Author(s):  
Akira Nakashima ◽  
Keyword(s):  
Polycystic Ovarian Syndrome ◽  
Gnrh Antagonist ◽  
Polycystic Ovary ◽  
Gonadotropin Releasing Hormone ◽  
Ovary Syndrome ◽  
Early Administration ◽  
Combined Use ◽  
Gnrh Antagonist Protocol ◽  
Ovarian Syndrome ◽  
Antagonist Protocol

Purpose: This study aimed to investigate the efficacy of withholding gonadotropins (coasting) and early administration of cabergoline in a flexible Gonadotropin-Releasing Hormone (GnRH) antagonist protocol for patients with Polycystic Ovarian Syndrome (PCOS).

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