Comparison of the Long-Acting GnRH Agonist Follicular Protocol with the GnRH Antagonist Protocol in Women Undergoing In Vitro Fertilization: A Systematic Review and Meta-analysis

Yang, Rui; Guan, Yichun; Perrot, Valérie; Ma, Juan; Li, Rong

doi:10.1007/s12325-020-01612-7

Cited by 27 publications

(17 citation statements)

References 24 publications

(39 reference statements)

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“…Treatment with a GnRH antagonist is a routine ovulation stimulation protocol and has been used to prevent premature LH surge since the 1990s (8,9). There are a large number of randomized controlled, prospective and retrospective studies on GnRH antagonist regimens that fully prove the effectiveness and safety of these regimens (10)(11)(12)(13). Regarding the PPOS protocols, although it has not been applied for a long time, studies have shown that it can achieve exact effectiveness and safety in different populations (19)(20)(21)(22).…”

Section: Future Prospectsmentioning

confidence: 99%

“…Gonadotropin-releasing hormone (GnRH) antagonist is the routine ovulation stimulation protocol ( 8 , 9 ). There are a large number of randomized controlled, prospective and retrospective studies on GnRH antagonist regimens that fully prove the effectiveness and safety of GnRH antagonist regimens ( 10 – 13 ). However, it has been reported that GnRH antagonist protocols have a 0.34% to 8.0% chance of failing to control the LH surge, and increased age and diminished ovarian reserve are the main risk factors ( 14 – 17 ).…”

Section: Introductionmentioning

confidence: 99%

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Comparison of the Cumulative Live Birth Rates of Progestin-Primed Ovarian Stimulation and Flexible GnRH Antagonist Protocols in Patients With Low Prognosis

Zhang

et al. 2021

Front. Endocrinol.

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ObjectiveTo compare the cumulative live birth rate (CLBR) of the progestin-primed ovarian stimulation (PPOS) protocol with that of the flexible GnRH antagonist protocol in patients with poor prognosis diagnosed per the POSEIDON criteria.MethodsThis was a retrospective cohort study. Low-prognosis women who underwent IVF/ICSI at the Reproductive Center of Third Affiliated Hospital of Zhengzhou University between January 2016 and January 2019 were included according to the POSEIDON criteria. The CLBR was the primary outcome of interest. The secondary outcome measures were the numbers of oocytes retrieved, 2PN embryos, available embryos and time to live birth.ResultsA total of 1329 women met the POSEIDON criteria for analysis. For POSEIDON group 1, the dosage of gonadotropin (Gn) was higher in the PPOS group than in the GnRH antagonist group (2757.3 ± 863.1 vs 2419.2 ± 853.1, P=0.01). The CLBR of the PPOS protocols was 54.4%, which was similar to the rate of 53.8% in the GnRH antagonist group. For POSEIDON group 2, the number of available embryos was higher in the PPOS group (2.0 ± 1.7 vs 1.6 ± 1.4, P=0.02) than in the GnRH antagonist group. However, the CLBRs of the two groups were similar (18.1% vs 24.3%, P=0.09). For POSEIDON groups 3 and 4, there were no statistically significant differences in the number of oocytes retrieved, 2PN, available embryos or CLBR between the two protocols. After adjustments for confounding factors, the CLBR remained consistent with the unadjusted rates. In the POSEIDON group 1 population, the GnRH antagonist protocols had a shorter time to live birth (P=0.04).ConclusionFor low-prognosis patients diagnosed per the POSEIDON criteria, the CLBR of PPOS protocols is comparable to that of GnRH antagonist protocols. In the POSEIDON group 1 population, the GnRH antagonist protocols resulted in a shorter time to live birth.

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Section: Future Prospectsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparison of the Cumulative Live Birth Rates of Progestin-Primed Ovarian Stimulation and Flexible GnRH Antagonist Protocols in Patients With Low Prognosis

Zhang

et al. 2021

Front. Endocrinol.

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“…A recently review combined and analysed seven studies, including proportions of normal ovarian responders, polycystic ovary syndrome (PCOS), and poor responders. Despite increased risk of ovarian hyperstimulation syndrome (OHSS), the long-acting GnRH agonist follicular protocol was still beneficial in improving live birth rate than GnRH antagonist protocol (25).…”

Section: A B Cmentioning

confidence: 99%

Prolonged pituitary downregulation with gonadotropin-releasing hormone agonist improves the live-birth rate: a retrospective cohort study comparing 3 different protocols

Ruan¹,

Fang²,

Yang³

et al. 2021

Ann Palliat Med

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Background: The long protocol has been recognized as the gold standard in controlled ovarian hyperstimulation (COH). However, the full dose of gonadotropin-releasing hormone agonist (GnRH-a) under the prolonged protocol has become increasingly popular in China. This study sought to compare pregnancy outcomes among the following 3 groups: a long protocol group, and 2 types of improved prolonged protocol groups.Methods: A retrospective cohort study was conducted of 550 patients undergoing fresh embryo transfer (ET). Patients were treated either with the improved prolonged protocol in the follicular phase (Group 1; n=288) or the mid-luteal phase (Group 2; n=143), or the long protocol (Group 3; n=119). The clinical and laboratory outcomes of the 3 groups were compared. Results:The general characteristics of the women in the 3 groups were comparable. On the day on which gonadotropin (Gn) was first administered and on the day on which human chorionic gonadotropin (hCG) was administered, the luteinizing hormone (LH) levels of patients in both Groups 1 and 2 were lower than those of patients in Group 3. The number of oocytes retrieved, fertilized, and cleaved, and the number of high-quality embryos in the 3 procedures were similar. However, the number of transferred embryos, the rate of blastocyst progression, and the rate of implantation differed. The clinical pregnancy rates (CPRs) were significantly higher in the prolonged protocol groups (62.5% and 61.5%) than the long protocol group (48.7%). Further, statistically significant differences in the live-birth rates (LBRs) (56.9% vs. 57.3% vs. 42.9%) were observed. However, no differences in early abortion rates were found.Conclusions: As a result of pituitary downregulation with GnRH-a, the prolonged groups had better CPRs and LBRs than the long protocol group. The prolonged protocol in the mid-luteal phase was equally effective as that in the early follicular phase in fresh in-vitro fertilization (IVF)/intracytoplasmic sperm injection-embryo transfer (ICSI-ET) cycles. High LH levels on the day of hCG may be a predictor of adverse clinical outcomes.

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“…The GnRH agonist and GnRH-ant protocols are well-established methods for controlled ovarian hyperstimulation among patients who are receiving assisted reproductive technology (ART) [11]. The GnRH-a protocol was developed in the 1980s and is used to prevent premature LH outpouring, thereby increasing the number of retrieved oocytes and pregnancy rates.…”

Section: Introductionmentioning

confidence: 99%

“…The GnRH-ant protocol was introduced in the 1990s; it can competitively block GnRH receptors and cause a rapid suppression of Gn release. The GnRH-ant protocol results in a lower risk of severe ovarian hyperstimulation syndrome (OHSS) and is more convenient for patients because of the shorter duration of Gn administration and lower Gn dose [11,12]. Current reports are not consistent in comparing the clinical outcomes of the GnRH-a and GnRH-ant protocols.…”

Section: Introductionmentioning

confidence: 99%

The GnRH Antagonist Protocol is Associated with a Higher Embryo Aneuploidy Rate Than the GnRH Agonist Long Protocol in Chinese Women

Wang¹,

Zhang²,

Zhao³

et al. 2021

Preprint

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Background: Studies in oocytes have suggested increased aneuploidy rates after ovulation induction in mammals and humans. Conversely, some studies have shown that ovarian stimulation does not significantly increase the embryo aneuploidy rate in humans compared with an unstimulated cycle. In addition, the potential effect of the gonadotropin-releasing hormone (GnRH) antagonist (GnRH-ant) protocol and GnRH agonist (GnRH-a) long protocol on embryo aneuploidy remains unknown.Methods: This is the retrospective cohort study from university-affiliated fertility center. In total, 578 early miscarriage patients who conceived through IVF/intracytoplasmic sperm injection (ICSI) after receiving the gonadotropin-releasing hormone (GnRH) antagonist (GnRH-ant) protocol or the GnRH agonist (GnRH-a) long protocol were analyzed to compare the aneuploidy rates in early aborted tissues. In addition, a total of 466 preimplantation genetic testing for aneuploidy (PGT-A) cycles undergoing GnRH-ant protocol or GnRH-a long protocol were also analyzed to compare the aneuploidy rates in embryo.Results: For early miscarriage patients who conceived through IVF/ICSI, compared to the GnRH-a long protocol group, the GnRH-ant protocol group had a significantly higher rate of aneuploidy in early aborted tissues (48.70% vs. 64.52%), and increased aneuploidy was associated with a significantly higher incidence of trisomy 13, 18, and 21 (p<0.01). Regarding PGT-A cycles, compared to the GnRH-a long protocol group, the rate of embryo aneuploidy was also significantly higher in the GnRH-ant protocol group (48.01% vs. 58%). After stratification and multiple linear regression, the GnRH-ant regimen remained significantly associated with an increased risk of aneuploidy in early aborted tissues and embryos [OR (95% CI) 1.767 (1.174, 2.661), OR (95% CI) 1.465 (1.020, 2.102)]. Furthermore, the embryo aneuploidy rate in the GnRH-ant protocol group was significantly higher than that in the GnRH-a long protocol group but only in young and normal ovarian responders [OR (95% CI) 3.54 (1.48, 8.46)].Conclusions: The GnRH-ant protocol is associated with a higher aneuploidy rate in early aborted tissues and embryos than the GnRH-a long protocol in Chinese women. A multicenter, randomized controlled trial would be the optimal strategy to confirm these results.

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Comparison of the Long-Acting GnRH Agonist Follicular Protocol with the GnRH Antagonist Protocol in Women Undergoing In Vitro Fertilization: A Systematic Review and Meta-analysis

Cited by 27 publications

References 24 publications

Comparison of the Cumulative Live Birth Rates of Progestin-Primed Ovarian Stimulation and Flexible GnRH Antagonist Protocols in Patients With Low Prognosis

Comparison of the Cumulative Live Birth Rates of Progestin-Primed Ovarian Stimulation and Flexible GnRH Antagonist Protocols in Patients With Low Prognosis

Prolonged pituitary downregulation with gonadotropin-releasing hormone agonist improves the live-birth rate: a retrospective cohort study comparing 3 different protocols

The GnRH Antagonist Protocol is Associated with a Higher Embryo Aneuploidy Rate Than the GnRH Agonist Long Protocol in Chinese Women

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