Administration of single-dose GnRH agonist in the luteal phase in ICSI cycles: a meta-analysis

Oliveira, J.B.A.; Baruffi, R.L.R.; Petersen, Claudia G.; Mauri, A.L.; Cavagna, M.; Franco, J.G.

doi:10.1186/1477-7827-8-107

Cited by 59 publications

(48 citation statements)

References 40 publications

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“…The possible mechanisms responsible for the effects of the GnRH agonist luteal action may be a direct beneficial effect on the embryos or uterine tissue. Nevertheless, it seems premature to recommend the use of the GnRH agonist in the luteal phase until further randomised controlled trials are provided [14].…”

Section: Dual Triggermentioning

confidence: 99%

Combined ovulation triggering with GnRH agonist and hCG in IVF patients

Kasum

Kurdija²,

Orešković

et al. 2016

Gynecological Endocrinology

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Section: Dual Triggermentioning

confidence: 99%

Combined ovulation triggering with GnRH agonist and hCG in IVF patients

Kasum

Kurdija²,

Orešković

et al. 2016

Gynecological Endocrinology

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Section: Discussionmentioning

confidence: 99%

“…The use of triptorelin as luteal support allows sustaining constantly small flares of endogenous pituitary gonadotropins which can stimulate and recover the function of corpora lutea [18]. At the same time, the aggressive luteal support with triptorelin appears to have a direct effect on endometrium and embryo by acting on a placental GnRH receptor [19].In the group of patients included in our study, the choice of an intensive luteal support with progesterone plus triptorelin, instead of estrogens [20] or hCG [21], produced good effects.Our results are in line with previous data which demonstrated that repeated dose of a GnRH agonist during luteal phase recover the luteal phase deficiencyand is compatible with normal implantation and pregnancy evolution [22]. We also observed that three patients achieved pregnancy after the implantation of frozen-thawed blastocyst, and one patient achieved pregnancy after the transfer of vitrified oocytes, enhancing the pregnancy rate per stimulation.…”

mentioning

confidence: 99%

The Use of Corifollitropin Alfa in Combination with a GnRH Analogue as Final Trigger in the Potential High Responders

Arnoldi¹

2014

JFIV Reprod Med Genet

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Background: A great concern exists in using corifollitropin alfa to induce ovarian stimulation in high responders due to the riskof OHSS.In this study, we utilized corifollitropin alfa in patients with the potential of being high responders, in addition to the GnRH analogue triptorelin, as final trigger to induce the oocyte maturation. An intensive luteal support was administered to allow the transfer in the same cycle. Patients and methods:Between January 2013 and September 2014, 35 patients were stimulated with corifollitropin alfa and underwent in vitro fertilization or intracytoplasmic sperm injection procedures. All women had levels of antimullerian hormone>3 ng/ml and antral follicle count >10 and <20. The patients with polycystic ovarian syndrome were excluded from the study. Results:The mean number of oocytes collected was 13.95 ± 6.04, the mean number of oocytes inseminated was 5.11 ± 1.66, the mean number of embryos obtained and transferred was 3.13 ±1.61 and 2.11 ± 0.92, respectively. All patients received a fresh embryo transfer,and the luteal phase was intensively supported by triptorelin and progesterone.A part of oocytes (2.47 ± 4.28) and blastocysts (0.39 ± 0.75) was vitrified.The clinical pregnancy was achieved in 15 patients and the ongoing pregnancy in11 women. Cumulative ongoing pregnancy rate, including the pregnancies achieved after thawing of eggs or embryos, was 39.47%. No OHSS were observed. Conclusions:Corifollitropin alfa plus triptorelin trigger elicits a safe ovarian stimulation in the potential high responderpatients. first day after insemination.Luteal phase was supportedby triptorelin 0.1 mg, one injection every other day from the embryo transfer, for a total of five injections. Additionally, 600 mg/day of micronized progesterone (Progeffik 200 mg, 3 cps/die) was started from the day of oocyte retrieval. A quantitative pregnancy test, done by dosing serum β-hCG, was performed 12 days after ovulation triggering with triptorelin and it was repeated 2 days later. In the presence of pregnancy, a transvaginal ultrasound was performed 28-32 days after the embryo transfer and repeated as required. Clinical pregnancy was confirmed if a fetal heartbeat was observed by transvaginal ultrasound. ResultsCharacteristics of ovarian stimulation and IVF/ICSI parameters are described in Table 1. Despite the patients included in this study had a high follicular response (14 women had over 15 oocytes retrieved), the ovarian stimulation protocol allowed to obtain a good fertilization rate and top-and good-quality embryos.Our results show that, in this group ofthe potential high responder patients, 15 clinical pregnancies and 11 ongoing pregnancies were achieved per fresh cycle ( Table 2). The cumulative ongoing pregnancy rate reached 39.47%, including 4 ongoing pregnancies which were obtained after the transfer of frozen-thawed oocyte (in one patient) and blastocysts (in three patients). Some of the pregnancies have already delivered the birth of a healthy baby. All patients reported good comp...

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“…Usually GnRHa firstly induces an augmented pituitary response (flare up effect) followed by gradually pituitary down regulation [5,6]. There was successful report in animal study that taking advantage of the initial flare-up effect and using ultra-low dose of short-acting GnRHa to achieve multiple follicles development without exogenous gonadotropines, it suggested that GnRHa alone could generate enough FSH level and duration for multiple follicles recruitment [7].…”

Section: Discussionmentioning

confidence: 99%

A case report: successful pregnancy after controlled ovarian hyperstimulation by using short-acting gonadotropin releasing hormone agonist only

Gong

Cai

Zhang

et al. 2012

J Assist Reprod Genet

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Controlled ovarian hyperstimulation (COH) is widely used in in vitro fertilization and embryo transfer (IVF-ET) to achieve multiple follicle development during one treatment cycle. COH is usually initiated by gonadotropin releasing hormone agonist (GnRHa) to down-regulate pituitary secretion of gonadotropins, suppress endogenous LH surge and synchronize multiple follicles development, which is followed by stepwise exogenous gonadotropins stimulation [1,2]. Here we report a case of successful pregnancy after inducing multiple follicles development by using short-acting GnRHa only.A 31-year-old woman, 50 kg weight, was administrated in our unit for four-year primary infertility. Her menstrual cycle was 28 days, lasting 6-7 days. The basal serum follicle-stimulating hormone (FSH), luteinizing hormone (LH) and estradiol (E2) level was 5.1 mIU/mL, 3.56 mIU/mL, and 38.81 pg/mL, respectively. The numbers of antral follicles were eight per ovary.In the mid-luteal phase, the patient was administrated of short-acting GnRHa (Decapeptyl, Ferring, Germany) 0.1 mg/day for pituitary down-regulation] to initiate an IVF treatment cycle. After 14 days administration, the serum FSH was 4.58 mIU/mL, LH was 29.23 mIU/mL, and E2 was 26.79 pg/mL. Transvaginal ultrasound examination showed that there were five follicles with average diameter more than 10 mm, and the largest one was 14 mm. 0.1 mg Decapeptyl was continuously given for one more day and the LH level maintained 29.96 mIU/mL. Then, we decreased the dose of GnRHa to 0.05 mg/day and continuously given for four more days. Ultrasound examination showed five follicles with average diameter more than 20 mm, the largest one was 28 mm. The patients' serum E2 increased to 1,270 pg/mL, LH was 13.51 mIU/mL. 0.05 mg Decapeptyl was continuously given in the morning and 10,000 IU human chorionic gonadotropin (hCG) was administered to trigger egg maturation in the evening. The patient was scheduled for oocyte retrieval 34 h after the hCG injection. Five oocytes were obtained and three fertilized successfully. Two grade I embryos at the 8-cell stage were transferred at d3, and a surplus grade I embryos at the 7-cell stage were frozen. Routine luteum support (UTROGESTAN 200 mg, Bid, Laboratoires Besins-Iscovesco, France) was given after embryo transfer (ET). Serum β-hCG level examined 14 days after ET was 613.9 mIU/mL, indicating a successful biochemical pregnancy. A transvaginal ultrasound examination 4 months after ET confirmed an ongoing intrauterine twin pregnancy. DiscussionIt is widely accepted that high serum LH level in follicular phase will affect the quality of oocytes and ultimately compromise the IVF outcome [3,4], therefore Porter in 1984 [1] firstly introduced the GnRHa into COH to suppress endogenous LH surge. Usually GnRHa firstly induces an augmented pituitary response (flare up effect) followed by

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Administration of single-dose GnRH agonist in the luteal phase in ICSI cycles: a meta-analysis

Cited by 59 publications

References 40 publications

Combined ovulation triggering with GnRH agonist and hCG in IVF patients

Combined ovulation triggering with GnRH agonist and hCG in IVF patients

The Use of Corifollitropin Alfa in Combination with a GnRH Analogue as Final Trigger in the Potential High Responders

A case report: successful pregnancy after controlled ovarian hyperstimulation by using short-acting gonadotropin releasing hormone agonist only

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