Clinical and Endocrine Effects of a Microdose GnRH Agonist Flare Regimen Administered to Poor Responders Who Are Undergoing In Vitro Fertilization

Surrey, Eric S.; Bower, JoAnn; Hill, David M.; Ramsey, Juliana; Surrey, M.

doi:10.1016/s0015-0282(97)00575-x

Cited by 230 publications

(141 citation statements)

References 18 publications

Supporting

Mentioning

126

Contrasting

Unclassified

Order By: Relevance

“…Women undergoing in vitro fertilization with low ovarian reserve and poor response to controlled ovarian hyperstimulation (COH) still present a management dilemma. Microdose GnRH-a flare protocols have been proven to be efficient in women with a history of a poor response to luteal phase protocols [1,4].…”

Section: Discussionmentioning

confidence: 99%

“…The microdoses of LA and the high doses of gonadotropins are then continued until the day of human chorionic gonadotropin (HCG) administration. Microdose GnRH-agonist (GnRH-a) flare protocol is especially preferred for poor responders who are undergoing in vitro fertilization and embryo transfer (IVF-ET) [1]. Basically, microdose GnRH-a protocol takes the advantages of both the agonist and down-regulation properties of GnRH agonist analogues.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Oral contraceptive pretreatment does not improve outcome in microdose gonadotrophin-releasing hormone agonist protocol among poor responder intracytoplasmic sperm injection patients

Duvan

Berker

Turhan

et al. 2008

J Assist Reprod Genet

View full text Add to dashboard Cite

Purpose To compare oral contraceptive (OC) pretreatment plus microdose GnRH-a in flare-up protocol and non-OC microdose GnRH-a in flare-up protocol among poor responder ICSI patients. Methods A retrospective analysis of poor responder ICSI patients. Patients were divided into two groups according to used microdose protocol. Precycle treatment with OC followed by follicular phase administration of 40 μg sc leuprolide acetate (LA) every 12 h beginning on after 2 day pill-free period and rFSH administration was begun on the third day of LA administration (OC-Group, n=26). Alternatively on day 2 after menses, patients were administered similar stimulation regime (non-OC Group, n=27). Results There were no significant differences between groups in the number of oocytes, peak estradiol levels, endometrial thickness, fertilization rates and embryo quality. Implantations and pregnancy rates per embryo transfer were similar. Conclusion OC pretreatment plus microdose GnRHa in flare-up protocol does not offer advantages over non-OC microdose GnRHa in flare-up protocol among poor responder ICSI patients.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Oral contraceptive pretreatment does not improve outcome in microdose gonadotrophin-releasing hormone agonist protocol among poor responder intracytoplasmic sperm injection patients

Duvan

Berker

Turhan

et al. 2008

J Assist Reprod Genet

View full text Add to dashboard Cite

show abstract

“…Changing from a long agonist protocol to a flare has been demonstrated to reduce the incidence of cycle cancellation for poor response (66). The use of antagonists has been proposed to benefit this group of patients on the premise that they afford reduced suppression of endogenous gonadotrophins.…”

Section: Poor Respondersmentioning

confidence: 99%

GnRH analogues: applications in assisted reproductive techniques

Hayden

2008

European Journal of Endocrinology

View full text Add to dashboard Cite

The ability to prevent an endogenous LH surge revolutionised the efficacy of assisted reproductive techniques (ART) such that GnRH agonists were rapidly adopted in the 1980s. Prior to this, premature luteinisation occurred in up to 25% of superovulated cycles leading to cycle cancellation and severely compromised outcomes. Analogues have been applied in a variety of drug protocols (long, short flare) but there has been little research to moderate the degree of pituitary suppression. There has also been ongoing and unresolved debate about the role of LH in supporting follicular development.By 2001, the first GnRH antagonists were registered for use in ART. Their ability to cause immediate suppression of gonadotrophin (particularly LH) secretion means that they can be given after exogenous stimulation has begun and thereby dramatically shorten the total duration of a treatment cycle. After initial enthusiasm and then scepticism that pregnancy rates may not be as high as the established agonist regimens, these preparations are now being increasingly adopted with at least comparable outcomes in large trials. They are certainly favoured by patients for their reduced side-effect profile and particularly for the shortening of the total cycle length. This shift in practice is occurring alongside gathering momentum in favour of milder stimulation protocols and a new perception of what constitutes successful treatment. The focus is moving away from surrogate outcomes such as oocyte numbers and conception rates towards long-term outcomes for women and their offspring, namely the achievement of a live singleton birth per treatment started.

show abstract

“…However, definite conclusions regarding the ideal approach for their treatment cannot yet be made, mainly due to the great variability among the studies performed (2). Recently, improved outcome has been reported with the application of the minidose GnRH-agonist flare-up protocol, which takes advantage of the initial pituitary stimulation (3,4). However, the application of GnRH-agonists in low responders, even in small doses and for a limited period, has been questioned as they may cause oversuppression of ovarian function, leading to a prolonged cycle and increased treatment costs, without improving the outcome (5).…”

Section: Ivf Unit Department Of Obstetrics and Gynecology Hebrewmentioning

confidence: 99%

Gonadotropin-Releasing Hormone (GnRH)-Antagonist Versus GnRH-Agonist in Ovarian Stimulation of Poor Responders Undergoing IVF

Fasouliotis

Laufer

Sabbagh-Ehrlich

et al. 2003

J Assist Reprod Genet

View full text Add to dashboard Cite

Purpose : The objective of this study was to compare the efficacy of GnRH-antagonists to GnRH-agonists in ovarian stimulation of poor responders undergoing IVF. Methods : Retrospective analysis of our data revealed that 56 patients underwent treatment with a GnRH-agonist according to the flare-up protocol. Patients failing to achieve an ongoing pregnancy (n = 53) were subsequently treated in the next cycle with a GnRH-antagonist according to the multiple-dose protocol. Main outcome measures included the clinical pregnancy and implantation rates. Results : While ovulation induction characteristics and results did not differ between the two protocols, the number of embryos transferred was significantly higher (P = 0.046) in the GnRH-antagonist than in the GnRH-agonist stimulation protocol (2.5 ± 1.6 vs. 2.0 ± 1.4, respectively). The clinical pregnancy and implantation rates per transfer in the GnRH-antagonist group appeared higher than in the GnRH-agonist, but did not differ statistically (26.1 and 10.7 compared with 12.2 and 5.9%, respectively). However, the ongoing pregnancy rate per transfer was statistically significantly higher (P = 0.03) in the GnRH-antagonist than in the GnRH-agonist group (23.9 vs. 7.3%, respectively). Conclusion : Applying GnRH-antagonists to ovarian stimulation protocols may offer new hope for IVF poor responder patients. However, further controlled randomized prospective studies with larger sample sizes are required to establish these results.

show abstract

Clinical and Endocrine Effects of a Microdose GnRH Agonist Flare Regimen Administered to Poor Responders Who Are Undergoing In Vitro Fertilization

Cited by 230 publications

References 18 publications

Oral contraceptive pretreatment does not improve outcome in microdose gonadotrophin-releasing hormone agonist protocol among poor responder intracytoplasmic sperm injection patients

Oral contraceptive pretreatment does not improve outcome in microdose gonadotrophin-releasing hormone agonist protocol among poor responder intracytoplasmic sperm injection patients

GnRH analogues: applications in assisted reproductive techniques

Gonadotropin-Releasing Hormone (GnRH)-Antagonist Versus GnRH-Agonist in Ovarian Stimulation of Poor Responders Undergoing IVF

Contact Info

Product

Resources

About