Depot versus daily administration of gonadotrophin releasing hormone agonist protocols for pituitary desensitization in assisted reproduction cycles

Albuquerque, LE; Saconato, Humberto; Maciel, MC

doi:10.1002/14651858.cd002808

Cited by 15 publications

(19 citation statements)

References 41 publications

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“…In this study, no severe hyperstimulation syndrome occurred; the incidence of mild-to-moderate OHSS was significantly higher in the long-acting group (9.1% vs 2.6%). According to a previous study, 23 the long-acting long protocol needed more Gn for ovarian stimulation compared with the short-acting long protocol. In this study, the Gn dosage in the two groups was 2316.16 ± 929.87 IU in the long-acting group vs 1808.58 ± 602.06 IU in the short-acting group, which was significantly different.…”

Section: Main Findingsmentioning

confidence: 95%

“…Reducing the level of LH could improve the oocyte development by increasing the estrogen/androgen ratio 4 ; moreover, it would improve the endometrial receptivity and wide implantation window. [5][6][7][8] A Cochrane review showed that the long protocol was associated with the best clinical pregnancy rate among the variety of controlled ovarian hyperstimulation (COH) protocols, 9 and was recommended by the National Institute for Health and Care Excellence. The long protocol has two forms: the long-acting and short-acting long protocol.…”

Section: Introductionmentioning

confidence: 99%

“…Usually, it deeply suppresses the pituitary, and, therefore, requires a greater amount of gonadotropin (Gn) and a longer duration of use. 7 The most effective form of agonist protocol remains controversial. In 2013, a meta-analysis study showed that it was not clear which one was the better protocol for pituitary desensitization in IVF cycles.…”

Section: Introductionmentioning

confidence: 99%

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Comparing the long‐acting and short‐acting forms of gonadotropin‐releasing hormone agonists in the long protocol of IVF/ICSI Cycles: A retrospective study

Duan

Bao

Teng

et al. 2017

J of Obstet and Gynaecol

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Aim: This study aimed to compare the efficacy of long-and short-acting gonadotropin-releasing hormone agonist on clinical outcomes of in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) long protocol cycles. Methods: In this retrospective study, 478 patients were enrolled from October 2012 to November 2014. The pituitary downregulation result, serum hormone levels, gonadotropin (Gn) dose during controlled ovarian hyperstimulation, and outcome of IVF/ICSI-embryo transfer were compared between the two groups. Results: Compared with the long-acting group, in the short-acting group the duration of downregulation and stimulation was significantly shorter; the total Gn doses, cost of an IVF cycle, rate of ovarian hyperstimulation syndrome, superior-quality embryo rate, and implantation rate were significantly lower; and the serum luteinizing hormone concentrations on the day of Gn and human chorionic gonadotropin administration were significantly higher. The serum estradiol level on the day of human chorionic gonadotropin was higher in the long-acting group. However, no significant differences were noted in other parameters. Conclusion: The long-acting group was associated with greater amounts of Gn and a longer duration of use for ovarian stimulation. This increased the cost per IVF cycle and may have had a detrimental effect on the pregnancy outcome because of a subsequent increase in the rate of ovarian hyperstimulation syndrome and decrease in the superior-quality embryo rate and implantation rate.

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Section: Main Findingsmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Comparing the long‐acting and short‐acting forms of gonadotropin‐releasing hormone agonists in the long protocol of IVF/ICSI Cycles: A retrospective study

Duan

Bao

Teng

et al. 2017

J of Obstet and Gynaecol

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“…In 2005, The Cochrane Collaboration reported no significant differences in outcomes after depot versus daily GnRH1a administration (25). What has received more attention has been the optimal protocol in which to apply them.…”

Section: Agonistsmentioning

confidence: 99%

GnRH analogues: applications in assisted reproductive techniques

Hayden

2008

European Journal of Endocrinology

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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.

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“…2,3 The long protocol can be divided into two types based on GnRHa administration that can be used to lead to hypophysis desensitization: one consisting of daily GnRHa low doses, and another with the administration of analogues in higher long-acting doses (depot). 4 A typical regimen using a depot of long-acting GnRHa, which we called the GnRHa-long protocol, was thought to be more comfortable for patients as it makes fewer applications, 5 and more flexible to start the controlled ovarian stimulation (COH). It still exists some weakness of the long protocol of higher fees, more complicated procedure and a higher risk of ovarian hyperstimulation syndrome (OHSS) after hCG trigger.…”

Section: Introductionmentioning

confidence: 99%

<p>Comparison Between PPOS and GnRHa-Long Protocol in Clinical Outcome with the First IVF/ICSI Cycle: A Randomized Clinical Trial</p>

Xi¹,

Tao²,

Qiu³

et al. 2020

CLEP

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Purpose: To investigate whether progestin-primed ovarian stimulation (PPOS) can be an alternative as gonadotrophin-releasing hormone agonist (GnRHa) long protocol for infertile women with normal ovarian reserve during IVF/ICSI. Methods: A prospective randomized controlled trial (RCT) including 257 patients was conducted between 1 August 2017 to 1 January 2018. Computerized randomization was performed to assign participants into two treatment groups at a 1:1 ratio: PPOS (130 patients) or GnRHa long protocol (127 patients) followed by their first IVF/ICSI with fresh/frozen embryo transfer. The primary outcome was the number of oocytes retrieved. Patients with normal ovarian reserve undergoing their first IVF/ICSI procedure were included. The embryological and clinical outcomes were measured. Only the first embryo transfer cycle was followed-up. Results: Basic characteristics such as infertility duration, age, and body mass index (BMI) were comparable in both groups. No significant difference was found in the number (mean ± SD) oocytes retrieved [11.8 ± 6.5 for PPOS vs 11.3 ± 5.6 for GnRHa long protocol] or viable embryos [4.5 ± 3.0 for PPOS vs 4.2 ± 2.9 for GnRHa long protocol] between the groups. No patient from either group experienced a premature LH surge during the whole process of ovarian stimulation. Besides, there was no moderate or severe ovarian hyperstimulation syndrome during the ovarian stimulation in PPOS group while three patients suffered it in the GnRHa long protocol group. There was no significant difference in the clinical pregnancy rate of the first embryos transfer cycle between the two groups. Conclusion: PPOS in combination with embryo cryopreservation as an ovarian stimulation regimen was as effective as GnRHa long protocol during controlled ovarian stimulation (COH) under different endocrinal mechanisms. It can also achieve comparable embryological and clinical outcomes while reducing the incidence of moderate and severe ovarian hyperstimulation syndrome (OHSS) and HMG dosage. It can be an alternative of the treatments for infertile patients with normal ovarian reserve undergoing IVF as well as traditional protocols.

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Depot versus daily administration of gonadotrophin releasing hormone agonist protocols for pituitary desensitization in assisted reproduction cycles

Cited by 15 publications

References 41 publications

Comparing the long‐acting and short‐acting forms of gonadotropin‐releasing hormone agonists in the long protocol of IVF/ICSI Cycles: A retrospective study

Comparing the long‐acting and short‐acting forms of gonadotropin‐releasing hormone agonists in the long protocol of IVF/ICSI Cycles: A retrospective study

GnRH analogues: applications in assisted reproductive techniques

<p>Comparison Between PPOS and GnRHa-Long Protocol in Clinical Outcome with the First IVF/ICSI Cycle: A Randomized Clinical Trial</p>

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