Different ART outcomes at increasing peak estradiol levels with long and antagonist protocols: retrospective insights from ten years experience

Manno, Massimo; Cervi, Marta; Zadro, Donatella; Fuggetta, Giuseppa; Adamo, Valter; Tomei, Francesco

doi:10.1007/s10815-011-9570-4

Cited by 9 publications

(5 citation statements)

References 29 publications

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“…Similar relationships with respect to the levels of estrogen but concerning in vitro fertilization were also observed. In these investigations, at a higher E2 level, the embryos obtained a better quality and dynamics of development [ 9 , 33 , 34 , 35 ].…”

Section: Discussionmentioning

confidence: 99%

Interactions of Cortisol and Prolactin with Other Selected Menstrual Cycle Hormones Affecting the Chances of Conception in Infertile Women

Wdowiak

Raczkiewicz

Janczyk

et al. 2020

IJERPH

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One of the major problems of success in infertility treatment could depend on the understanding how the potential factors may affect the conception. The aim of this study was to evaluate present understanding of such factors or hormonal causes that may induce infertility. We studied the interactions between the two menstrual cycle hormones i.e., cortisol (COR) and prolactin (PRL), along with the ultrasonographic ovulation parameters in a group of N = 205 women with diagnosed infertility. The control group consisted of N = 100 women with confirmed fertility. In both groups, follicle-stimulating hormone (FSH), luteinizing hormone (LH), anti-Müllerian hormone (AMH), thyroid stimulating hormone (TSH), PRL, COR were examined on the third day of the cycle, and estradiol (E2), progesterone (P), and COR were examined during ovulation and 7-days afterwards. In the infertile group, higher levels of PRL and COR were observed than that of in the control group. Cortisol levels at all phases of the menstrual cycle and PRL negatively correlated with E2 secretion during and after ovulation, thus contributed to the attenuation of the ovulatory LH surge. Infertile women who conceived presented with higher levels of E2 during and after ovulation, higher P after ovulation, and thicker endometrium than that of the women who failed to conceive. In conclusion, elevated secretion of COR and PRL in infertile women impairs the menstrual cycle by decreasing the pre-ovulatory LH peak and E2 and postovulatory E2 levels that affect the endometrial growth, and consequently reduce the chances to conceive.

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Section: Discussionmentioning

confidence: 99%

Interactions of Cortisol and Prolactin with Other Selected Menstrual Cycle Hormones Affecting the Chances of Conception in Infertile Women

Wdowiak

Raczkiewicz

Janczyk

et al. 2020

IJERPH

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“…The level of E 2 in women with PCOS is significantly higher in the GnRH agonist than that in the GnRH antagonist protocol (16). Manno et al (17) reported that in cycles in which E 2 levels are ≤3,000 pg/ml, there was only a trend that favors the implantation rate in the GnRH agonist, while in cycles with E 2 levels ≥3,000 pg/ml the implantation rate was significantly higher in the GnRH antagonist protocol. The results of a systematic review (18) revealed that IVF-ET patients with supposed normal responses instead of PCOS have significantly lower E 2 values on the day of hCG, number of oocytes retrieved and incidence of OHSS with the GnRH antagonist protocol compared with those of the GnRH agonist protocol.…”

Section: Discussionmentioning

confidence: 99%

GnRH antagonist for patients with polycystic ovary syndrome undergoing controlled ovarian hyperstimulation for in vitro fertilization and embryo transfer in fresh cycles

Zhai

Zhang

et al. 2017

Experimental and Therapeutic Medicine

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Abstract. The aim of the present study was to evaluate the influence of a gonadotropin-releasing hormone (GnRH) antagonist compared with a GnRH agonist on the in vitro fertilization cycle outcome in patients with polycystic ovary syndrome. The outcomes of pregnancy were evaluated. The area under the curve (AUC) of the receiver operating characteristic (ROC) curve was also used to evaluate whether the endometrial thickness (cm) and estradiol (E 2 ) level (pg/ml) on the day of human chorionic gonadotropin (hCG) administration (the hCG day) had the best sensitivity and specificity for predicting a clinical pregnancy. The results demonstrated that there were significant differences in the E 2 and progesterone levels between the two treatment groups on the hCG day. Furthermore, the mean number of total oocytes retrieved, mean number of 2 pronuclei oocytes, mean number of oocytes cleaved (P<0.05), mean number of embryos available (P=0.022) and mean number of embryos transferred (P=0.014) were significantly different. Additionally, the rates of ectopic pregnancy (P=0.984) and ovarian hyperstimulation syndrome (P= 0.976) did not differ significantly between the treatment groups. Although the biochemical pregnancy (P=0.592), clinical pregnancy (P=0.617) and live birth (P=0.365) rates were lower with the GnRH antagonist than with the GnRH agonist, there were no significant differences in the outcomes between the two groups. Analysis of the influence of endometrial thickness with respect to the clinical pregnancy using the ROC (AUC) method revealed that when the best cutoff of 9.75 cm was used, the sensitivity was 62.5%, the specificity was 43.1% and the AUC was 0.53. Additionally, the Youden index was 0.056. Analysis of the influence of the E 2 level on the hCG day on clinical pregnancy, using the ROC (AUC) method showed that the best cutoff was 2,984.5 pg/ml, which had a sensitivity of 68.8% and specificity of 52.9%, while the AUC was 0.573 (with a Youden index of 0.217). Furthermore, the results demonstrated that neither the endometrial thickness nor the E 2 level on the hCG day had the best sensitivity and specificity for predicting a clinical pregnancy.

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“…In the selection of agonist protocol for ovarian stimulation in patients with high AMH levels, Nelson et al and Manno et al reported an increase in pregnancy rate. Moreover, it was accompanied by an increase in the incidence of ovarian hyperstimulation syndrome (OHSS) and canceled cycles ( 17 , 32 ). In contrast to these results, the molecular studies on the oocytes, obtained through the antagonist protocol in patients with high AMH levels, indicated that the gene expressions of ATPase and BMP15 , as two indicators of oocyte quality, enhanced through the antagonist protocol ( 4 ).…”

Section: Discussionmentioning

confidence: 99%

A comparative study on the results of agonist and antagonist protocols based on serum AMH levels in patients undergoing intracytoplasmic sperm injection

Nikmard

Aflatoonian²,

Hosseini

et al. 2016

IJRM

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Background:Serum concentrations of antimullerian hormone (AMH) correlate with ovarian response during assisted reproduction treatment (ART) cycles.Objective:This retrospective study attempted to evaluate the selection of ovarian stimulation protocols based on serum AMH levels in patients and its impact on the results of ART.Materials and Methods:Based on AMH levels, the patients with tubal factor infertility were divided in three groups of normal, low and high AMH levels. Oocyte, good embryo number and pregnancy rate in each group were analyzed. Results:Using agonist and antagonist protocols, an increase in serum AMH led to higher number of oocytes and better quality embryos. At all low, normal and high AMH levels, the agonist protocol led to a more significant increase in the number of oocytes than the antagonist protocol (p<0.05). The number of high quality embryos significantly increased by the agonist protocol than antagonist protocol in women with normal AMH levels of 1.3-2.6 ng/ml (p=0.00). Moreover, the results for the number of high quality embryos at AMH ˃2.6 ng/ml was in favor of the antagonist protocol (p=0.00). The results showed the lowest pregnancy rate at AMH ˂1.3 ng/ml. At AMH ˃2.6 ng/ml, there was a significant increase in pregnancy rate through the antagonist protocol (p=0.04). Conclusion:Findings of this study suggested that the ART results are predictable, taking into account the AMH levels. The protocol specific to each patient can be used given the AMH level in each individual. This is because the results of each protocol depend on individual conditions.

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Different ART outcomes at increasing peak estradiol levels with long and antagonist protocols: retrospective insights from ten years experience

Abstract: In high responders long protocol seems to work better than antagonist when peak E2 is lower than 3,000 pg/ml but the opposite may be true for cycles with higher E2 levels.

Cited by 9 publications

References 29 publications

Interactions of Cortisol and Prolactin with Other Selected Menstrual Cycle Hormones Affecting the Chances of Conception in Infertile Women

Interactions of Cortisol and Prolactin with Other Selected Menstrual Cycle Hormones Affecting the Chances of Conception in Infertile Women

GnRH antagonist for patients with polycystic ovary syndrome undergoing controlled ovarian hyperstimulation for in vitro fertilization and embryo transfer in fresh cycles

A comparative study on the results of agonist and antagonist protocols based on serum AMH levels in patients undergoing intracytoplasmic sperm injection

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