Comparison of early versus late initiation of GnRH antagonist co-treatment for controlled ovarian stimulation in IVF: a randomized controlled trial

Hamdine, O.; Macklon, Nicholas S.; Eijkemans, Marinus J.C.; Laven, Joop S.E.; Cohlen, Bernard J.; Verhoeff, Arie; Dop, P.A. van; Bernardus, Rob E.; Lambalk, Cornelis B.; Oosterhuis, G.J.E.; Holleboom, C.A.G.; Maasland, G.C. van den Dool –; Verburg, Harjo; Heijden, P.F.M. van der; Blankhart, A.; Fauser, Bart C.J.M.; Broekmans, Frank J.

doi:10.1093/humrep/det374

Cited by 12 publications

(7 citation statements)

References 43 publications

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“…The potential detrimental effect of the GnRH antagonist upon the developing embryo may be significantly diminished after 2 days of insemination. This could be the reason for a lack of any significant negative effect of GnRH antagonists on pregnancy and live birth outcome [26][27][28]. Based on the results in Table 3 and previous reports, early cleavage of the zygote is not a reliable predictor for pregnancy potential using the GnRH antagonist protocol.…”

Section: Discussionmentioning

confidence: 78%

Embryonic early-cleavage rate is decreased with aging in GnRH agonist but not inantagonist protocols

Yang

Hwang

Lin

et al. 2015

J Assist Reprod Genet

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Purpose The aim of this study was to evaluate the correlation between embryonic early-cleavage status and the age of patients receiving either a GnRH agonist long protocol or a GnRH antagonist protocol. Methods This retrospective study included 534 patients undergoing a fresh cycle of oocyte retrieval and day-3 embryo transfer. Of the 534 patients treated, 331 received a GnRH agonist long stimulation protocol (GnRH agonist group) for ovarian stimulation and 203 patients received a GnRH antagonist protocol (GnRH antagonist group).Results By logistic regression analysis, the rate of embryonic early-cleavage was significantly decreased with increasing age of women in the agonist (P<0.001) but not in antagonist groups (P=0.61). Based on the results of this study, maternal age is a critical factor for embryonic early-cleavage in agonist protocol but not in antagonist protocol. The results also showed that early-cleavage embryos were of better quality and resulted in a higher pregnancy rate than late-cleavage embryos in the GnRH agonist group. However, embryo quality and pregnancy rate was not significantly different between early and late cleavage embryos in the GnRH antagonist group. Conclusions We conclude that embryonic early-cleavage status is negatively correlated with aging in women receiving GnRH agonist long down-regulation but not in GnRH antagonist protocols. We also conclude that early cleavage of the zygote is not a reliable predictor for pregnancy potential using the GnRH antagonist protocol.

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Section: Discussionmentioning

confidence: 78%

Embryonic early-cleavage rate is decreased with aging in GnRH agonist but not inantagonist protocols

Yang

Hwang

Lin

et al. 2015

J Assist Reprod Genet

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“…3,4 A randomized controlled trial by Hamdine O et al on comparison of early versus late initiation of GnRH antagonist in elevated p group also demonstrated no statistically significant difference in ongoing pregnancy rate. 12 A prospective interventional study and systemic metaanalysis review by Hamdine and nicks et al found that early elevated progesterone levels were associated with lower ongoing pregnancy rate in GnRH antagonist but the result was not statistically significant. 13 No differential impact of early or late GnRH antagonist initiation on the effect of elevated or normal progesterone on ongoing pregnancy rate was observed.…”

Section: Discussionmentioning

confidence: 99%

Day-2 serum progesterone level and IVF/ICSI outcome: a comparative study

Mahapatro

Radhakrishan

2017

Int J Reprod Contracept Obstet Gynecol

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Background: Purpose of this study was to evaluate the in vitro fertilisation outcome in patients having normal or elevated day-2 serum progesterone level undergone IVF by using GnRH antagonist.Methods: A retrospective study conducted in Institute of Reproductive Medicine, Chennai during January 2013 to March 2014. According to patient’s Day-2 serum progesterone level the total no of cases (N=151) were divided into two groups group-1 (N=116) with progesterone value ≤1.5ng/ml and group-2 (N=35) with progesterone value>1.5ng/ml. Ovarian stimulation was started with recombinant FSH on day 2 and GnRH antagonist injections started from day 6 of stimulation. Total dose of gonadotropins, days of gonadotrophin injections, no of eggs collected, Clinical pregnancy rate and live birth rate were compared between two groups.Results: Two groups were similar with regards to age, BMI, days of gonadotrophins and total doses of gonadotrophins. Incidence of elevated P level was 23.17%. Total pregnancy rate was 36.42%. A non-statistically-significant difference was observed in clinical pregnancy (37.06% vs 34.28%) and live birth (32.75% vs 28.57%) between the normal and elevated progesterone groups.Conclusions: Elevated day-2 serum progesterone level was associated with lower clinical pregnancy rate but it was not statistically-significant.

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“…Thus, the negative effects observed in this study might be associated to these facts and not necessarily be present in antagonist treatments that are scheduled using cycle programming that allows a planned treatment start or when antagonist initiation is determined by ultrasonographically estimated follicle size and estradiol levels. However, a previous randomized study supports that delaying the start of GnRH antagonist treatment may be equally effective as early initiation, making possible the programming of antagonist cycles as well .…”

Section: Discussionmentioning

confidence: 99%

Weekend‐free scheduled IVF/ICSI procedures and single embryo transfer do not reduce live‐birth rates in a general infertile population

Feichtinger

Karlström

Olofsson

et al. 2017

Acta Obstet Gynecol Scand

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IntroductionScheduling of ovum pickup only on weekdays may result in cases of apparently suboptimal timing for human chorionic gonadotropin and ovum pickup. This study aimed to assess whether live‐birth rates were reduced in women with a potentially suboptimal day for human chorionic gonadotropin and ovum pickup to avoid weekend work, according to ultrasonographic data on the day of human chorionic gonadotropin planning.Material and methodsAn evaluation of the optimal human chorionic gonadotropin priming date was performed in treatment protocols of 1000 consecutive patients undergoing their first in vitro fertilization/intracytoplasmatic sperm injection with single‐embryo transfer. An ideal ovum pickup day was characterized by human chorionic gonadotropin‐scheduling when three or more follicles reached 17 mm (day 0) or with one day of delay (day +1) (n = 760). A non‐ideal ovum pickup was either early (day −1, −2, −3) (n = 24) or delayed (day +2, +3, +4) (n = 216). Live‐birth rates in the ideal and non‐ideal ovum pickup groups was set as primary outcome measure.ResultsEarly‐ovum pickups were excluded as they were infrequent. No differences between ideal and delayed ovum pickup groups were found regarding number of oocytes retrieved (9.87 vs. 9.78, p = 0.990), pregnancy rates (28.3% vs. 29.6%, p = 0.701) or live‐birth rates (26.2% vs. 25.9%, p = 0.939). However, sub analyses indicated that treatment with gonadotropin releasing hormone antagonists resulted in significantly lower clinical pregnancy rates in delayed ovum pickups (odds ratio 0.46, p = 0.014), compared with agonist treatments.ConclusionsWeekend work may not be needed for in vitro fertilization/intracytoplasmatic sperm injection single‐embryo transfer treatments. However, in gonadotropin releasing hormone antagonist cycles, delaying ovum pickup more than one day may result in unfavorable outcomes.

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Comparison of early versus late initiation of GnRH antagonist co-treatment for controlled ovarian stimulation in IVF: a randomized controlled trial

Abstract: www.clinicaltrials.gov, no. NCT00866034.

Cited by 12 publications

References 43 publications

Embryonic early-cleavage rate is decreased with aging in GnRH agonist but not inantagonist protocols

Embryonic early-cleavage rate is decreased with aging in GnRH agonist but not inantagonist protocols

Day-2 serum progesterone level and IVF/ICSI outcome: a comparative study

Weekend‐free scheduled IVF/ICSI procedures and single embryo transfer do not reduce live‐birth rates in a general infertile population

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