Application of GnRH antagonist in combination with clomiphene citrate and hMG for patients with exaggerated ovarian response in previous IVF/ICSI cycles

Abstract

Purpose To investigate if the combination of clomiphene citrate, hMG, and cetrorelix (CC/hMG/cetrorelix protocol) can be applied to patients who had excessive response to GnRHa long protocol. Methods Fifty patients who coasted and failed to conceive in their first cycles stimulated with GnRHa long protocol were stimulated with CC/hMG/cetrorelix protocol. The peak serum estradiol levels, the need of coasting and prolonged coasting (≥4 days), and the incidences of OHSS were compared.Results The peak estradiol level was significantly lower with CC/hMG/cetrorelix protocol compared to GnRHa long protocol. With CC/hMG/cetrorelix protocol, only four patients (8%) needed coasting and no one coasted ≥4 days. In contrast, in the first cycles, 11 patients (22%) needed coasting ≥4 days. The incidence of moderate OHSS was significantly lower with CC/hMG/cetrorelix protocol. Conclusions The CC/hMG/cetrorelix protocol is an acceptable alternative protocol for patients who had excessive response to GnRHa long protocol.

GnRH agonist and GnRH antagonist protocols in ovarian stimulation: differential regulation pathway of aromatase expression in human granulosa cells

“…These results suggest that long-term treatment by GnRH agonist, in contrast to GnRH antagonist, induces PKC desensitization in human granulosa cells, suppressing its wellknown inhibitory effect on gonadotrophin-induced steroidogenesis. Therefore the GnRH antagonist protocol is used to prevent ovarian hyperstimulation syndrome in women undergoing ovarian stimulation (Hsieh et al, 2008;Lin et al, 2007). The markedly reduced PKC activity recorded in granulosa cells from GnRH agonist-treated cells support this hypothesis.…”

Effect of estradiol valerate on endometrium thickness during clomiphene citrate‐stimulated ovulation

“…Clomiphene citrate (CC) is an orally active non‐steroidal estrogen agonist/antagonist that is widely used as the first‐line ovulation inducer in anovulatory women . Nowadays, CC is useful in a variety of indications, such as induction of superovulation in unexplained infertility and the stimulation protocol for in vitro fertilization (IVF) cycles . CC has several marked advantages for these indications, because it is highly effective in inducing ovulation, while relatively safe, inexpensive and can be administered orally .…”

“…1,2 Nowadays, CC is useful in a variety of indications, such as induction of superovulation in unexplained infertility 3 and the stimulation protocol for in vitro fertilization (IVF) cycles. [4][5][6] CC has several marked advantages for these indications, because it is highly effective in inducing ovulation, while relatively safe, inexpensive and can be administered orally. 1 However, despite the fact that CC administration in anovulatory patients can improve ovulation rate by 60-85%, the pregnancy rate linked to CC treatment is noticeably lower than expected (only around 30-40%).…”

Live birth after rescue in vitro maturation–intracytoplasmic sperm injection in type 1 diabetes, polycystic ovary syndrome patient using clomiphene–antagonist protocol

“…[ 3 ] The protocol involving clomiphene citrate (CC), human menopausal gonadotropin (hMG), and cetrorelix helps women with PCOS as the incidences of moderate and severe OHSS are reduced. [ 4 ] It is evident that CC/hMG protocol has resulted in a significantly lower incidence of severe OHSS when compared to GnRA long protocol. [ 5 ] Moreover, it was also suggested that protocol involving gonadotropin-releasing hormone (GnRH) antagonist plus mild doses of exogenous gonadotropins and oral compounds such as CC or aromatase inhibitors was more patient friendly.…”