Prevention of Premature Ovulation by Administration of Gonadotropin Releasing Hormone Antagonist the day After Ovulation Triggering in Diminished Ovarian Reserve Patients

Abstract

Objective The aim of the present retrospective study was to investigate the effectiveness of single-dose gonadotropin releasing hormone (GnRH) antagonist administration, the day after human chorionic gonadotropin (hCG) triggering for final oocyte maturation, on the prevention of premature luteinization in patients with diminished ovarian reserve in in-vitro fertilization (IVF) cycles. The secondary objective of the study was to search the effect of this protocol on pregnancy outcomes. Methods This is a retrospective study including 267 infertile patients who have single antral follicle seen with ultrasonography on the 2nd or 3rd day of the menstrual cycle before starting IVF treatment. We randomized patients into two groups. The case group comprised patients who had single-dose GnRH antagonist injection the day after hCG triggering formed, and the patients who had the standard treatment regime formed the control group. In both groups, the oocytes were collected 36 hours after hCG injection. Results The premature ovulation rate was significantly low in the case group compared with the control group (6.86 versus 20.6% per scheduled cycle) (p = 0.022). Also, the oocyte retrieval rate (93.14 versus 67.87% per scheduled cycle) (p = 0.013), the oocyte maturity rate (79.42 versus 47.87%) (p = 0.041), the fertilization rate (65.68 versus 34.54%) (p = 0.018), and the embryo transfer rate per scheduled cycle (44.11 versus 18.78%) (p = 0.003) were higher in the GnRH antagonist group than in the control group. Conclusion The administration of GnRH antagonist the day after hCG trigger in IVF treatments of patients with diminished ovarian reserve enabled a significant decrease in the rate of premature ovulation but had no effect on live birth rate.

Hormonal Pretreatment for Ovarian Stimulation: A Narrative Review

“…From stimulation day 6 onwards, women's gonadotropin doses were adjusted according to serum E2 levels and ovarian response, which was assessed through vaginal ultrasonography every 2 days. For patients treated with E2 (n=50), doses of E2 valerate were started on day 20 of the menstrual cycle prior to the IVF/ICSI cycle at a daily dose of 4 mg (2 mg twice daily) orally for 5 to 12 days, until the day before the start of ovarian stimulation, regardless of the specific day of the onset of menstruation [12]. No significant differences were observed in the number of oocytes retrieved, fertilization rates, number of top-quality embryos or number of transferred embryos [13].…”

“…Using research databases, information is identified, selected, analyzed, and synthesized. The knowledge imparted by the general conclusion of the study enables enhancement of patient care and improvement in the professional routine [12].…”

Fetal Metabolic Programming in the Etiology of Polycystic Ovarian Syndrome

“…(7,12,14) The GnRH pulse in women with PCOS shows a predominance of LH synthesis, which stimulates the theca cells to convert cholesterol into androstenedione, one of the androgenic hormones. (12,15,16) As a result, the body enters a stage of hyperandrogenism. Furthermore, FSH will be released in less quantity by the pituitary gland, and the ovary, in turn, will not produce estrogen properly.…”

The effects of flexible short protocol with gonadotropin-releasing hormone antagonist on preventing premature ovulation in poor responders

“…In patients with POR, LH spontaneous surges often appear as hidden peaks; therefore, it is difficult to control spontaneous premature ovulation, which is also one of the main reasons for the high cancellation rate. Gonadotropin-releasing hormone antagonist (GnRH-ant) can rapidly inhibit LH secretion [ 18 ], thus preventing premature luteinization and ovulation in COS [ 19 , 20 ]. Some studies showed that GnRH-ant may affect follicle growth and endometrial receptivity [ 21 ].…”