Effect of Prolonged GnRH Agonist Downregulation on ICSI Outcome in Patients With Endometriomas of Less Than 5 cm: A Randomized Controlled Trial

Maged, Ahmed M.; Rashwan, Hamsa; Mahmoud, Maryam; El-Mazny, Akmal; Farouk, Mona; Belal, Doaa S.; Marie, Heba

doi:10.1177/1933719118756753

Cited by 9 publications

(9 citation statements)

References 37 publications

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“…The full texts of 64 remaining articles were reviewed for inclusion, and finally 9 RCTs were considered eligible for systematic review and meta‐analysis. [ 11,17–24 ] Details of the study selection process are shown in Figure 1.…”

Section: Resultsmentioning

confidence: 99%

“…There was an improvement in clinical pregnancy rate in the meta‐analysis reported in 2020 between ultra‐long protocol and long protocol in patients with stages III–IV endometriosis ( P < 0.05), while no statistically significant difference was found in our meta‐analysis ( P = 0.17). This might because we excluded Maged 2018 [ 23 ] due to no description of ASRM stage and included Mo 2011 [ 20 ] in subgroup analysis. Those differences indicate that the usage of ultra‐long protocol in patients with stages III–IV endometriosis still remains uncertain.…”

Section: Discussionmentioning

confidence: 99%

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Effectiveness of ultra‐long protocol on in vitro fertilization/intracytoplasmic sperm injection‐embryo transfer outcome in infertile women with endometriosis: A systematic review and meta‐analysis of randomized controlled trials

Liu

Xie

et al. 2021

J of Obstet and Gynaecol

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Objective To evaluate the effectiveness of ultra‐long protocol on reproductive and controlled ovarian hyperstimulation outcome in in vitro fertilization/intracytoplasmic sperm injection‐embryo transfer (IVF/ICSI‐ET) in infertile women with endometriosis versus long protocol. Methods We retrieved articles without language restrictions in the Elsevier ScienceDirect, Embase, Medline, PubMed, Web of Science, China National Knowledge Infrastructure, Wan Fang Data Knowledge Service Platform and China Science and Technology Journal Database from inception to August 2020. RCTs including the comparison of reproductive outcome of infertile patients with endometriosis who underwent ultra‐long protocol and long protocol were selected. Data extraction was conducted using RevMan 5.3. Results A total of nine RCTs in compliance with the standard literature were included. This meta‐analysis suggested that ultra‐long protocol with a 3‐month downregulation could increase clinical pregnancy rate of infertile women with endometriosis (RR=1.31, 95% CI:1.11 ~ 1.55, P = 0.002) versus long protocol. However, subgroup analysis found the different protocol provided no significant difference in improving clinical outcomes in patients with different disease stage of endometriosis. Conclusion The ultra‐long protocol could improve the clinical pregnancy rate of infertile women with endometriosis compared with long protocol with a 3‐month downregulation. And ultra‐long protocol could be effective to increase the ongoing pregnancy rate compared to long‐protocol. But, the efficacy of ultra‐long protocol is not different between early and advanced stage of endometriosis.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Effectiveness of ultra‐long protocol on in vitro fertilization/intracytoplasmic sperm injection‐embryo transfer outcome in infertile women with endometriosis: A systematic review and meta‐analysis of randomized controlled trials

Liu

Xie

et al. 2021

J of Obstet and Gynaecol

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“…The prolonged GnRH‐a protocol is mainly used in patients with endometriosis or endometrioma 18,19 . Recently, this protocol has also been used in patients with polycystic ovarian syndrome or in general IVF populations and has achieved better outcomes 6,20 .…”

Section: Discussionmentioning

confidence: 99%

“…17 The prolonged GnRH-a protocol is mainly used in patients with endometriosis or endometrioma. 18,19 Recently, this protocol has also been used in patients with polycystic ovarian syndrome or in general IVF populations and has achieved better outcomes. 6,20 This may be associated with the reduction of cytotoxic cytokines, oxidative stress, and the improvement of endometrial receptivity after prolonged use of GnRH-a.…”

Section: Discussionmentioning

confidence: 99%

Comparison of two gonadotropin‐releasing hormone agonist suppression protocols for in vitro fertilization in young patients with low body mass index

Cai

Shi

2022

Intl J Gynecology & Obste

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Objective To evaluate two different gonadotropin‐releasing (pituitary downregulating) hormones used in in vitro fertilization (IVF) on the live birth rate in young patients with low body mass index (BMI) undergoing their first IVF cycle. Methods In a retrospective study in a single public medical center, 555 long gonadotropin‐releasing hormone agonist (GnRH‐a) protocols were compared with 431 prolonged GnRH‐a protocols between 2016 and 2018. All analyses were performed using the SPSS version 22.0. The primary measured outcome was live birth rate. Results Compared with the long protocol, the prolonged protocol required more doses of gonadotropin and a longer duration of ovarian stimulation. Lower levels of serum luteinizing hormone and serum estrogen were detected on the day of chorionic gonadotropin administration, and a lower fertilization rate was found in the prolonged protocol. Although more oocytes were retrieved and more frozen embryos were recorded in the prolonged protocol, the live birth rate per fresh cycle was comparable between the two protocols (P = 0.057). The incidence of ovarian hyperstimulation syndrome was higher in the prolonged protocol group. In the subgroup of women with antral follicle count (AFC) of 12 or less, there was no difference in the live birth rate between the two protocols (P = 0.688). However, for women with AFC > greater than 12, the prolonged protocol was still a positive predictor of live birth rate. The odds ratio was 1.73 (95% confidence interval 1.04–2.89). Conclusion The prolonged protocol might not increase the live birth rate in women with low BMI who are undergoing their first IVF cycle. However, for women with AFC greater than 12, a prolonged protocol could be a good choice to improve the live birth rate.

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“…Prolonged GnRH-agonist protocol, GnRH-antagonist protocol and mild stimulation protocol are all based on the comparison of this stimulation protocol. Compared with the standard GnRH-agonist protocol, prolonged GnRH-agonist protocol increased the down-regulation time, mostly used in IVF-ET treatment of endometriosis [19]. In PCOS treatment, the prolonged GnRH-agonist protocol increased the endometrial receptivity by prolonging the down regulating time, thus increasing the implantation rate and pregnancy rate, but did not increase the incidence of OHSS [20].…”

Section: Discussionmentioning

confidence: 99%

The key factors affecting cumulative live birth rate after single oocyte retrieved in women during IVF/ICSI-ET: a retrospective analysis of 1380 PCOS patients

Xia

Tan

et al. 2021

Preprint

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Background: The factors affecting the cumulative live birth rate (CLBR) of PCOS patients who received in vitro fertilization/intracytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET) are unknown.Methods: Here we carried out a retrospective analysis of 1380 PCOS patients who received IVF/ICSI-ET for the first time from January 2014 to December 2016. According to the cumulative live births of PCOS patients after single oocyte collection, they were divided into cumulative live births group (group A) and non-cumulative live births group (group B).Results: The conservative cumulative live birth rate was 63.48%. There were 876 cumulative live births (group A) and 504 non-cumulative live births (group B) according to whether the patients had live births or not. Competition analysis showed that duration of infertility, primary/secondary type of infertility, stimulation protocols, starting dose of gonadotrophins and oocyte retrieved numbers were significantly correlated with CLBR. The Cox proportional risk regression model of PCOS patients showed that stimulation protocols had a significant impact on CLBR. Patients in the GnRH-antagonist protocol group and the mild stimulation protocol had lower CLBR than those in the Prolonged GnRH-agonist protocol, which was statistically significant. PCOS patients with the starting dose of gonadotrophins greater than 112.5u had lower CLBR than those with less than 100u, which was statistically significant. Women with 11-15 oocytes and 16-20 oocytes had higher CLBR than women with 1-9 oocytes, which was statistically significant.Conclusions: According to our statistical results, patients with PCOS represent a challenge for reproductive medicine.

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Effect of Prolonged GnRH Agonist Downregulation on ICSI Outcome in Patients With Endometriomas of Less Than 5 cm: A Randomized Controlled Trial

Abstract: Prolonged GnRH agonist downregulation improves the pregnancy rates in patients with small endometriomas undergoing ICSI.

Cited by 9 publications

References 37 publications

Effectiveness of ultra‐long protocol on in vitro fertilization/intracytoplasmic sperm injection‐embryo transfer outcome in infertile women with endometriosis: A systematic review and meta‐analysis of randomized controlled trials

Effectiveness of ultra‐long protocol on in vitro fertilization/intracytoplasmic sperm injection‐embryo transfer outcome in infertile women with endometriosis: A systematic review and meta‐analysis of randomized controlled trials

Comparison of two gonadotropin‐releasing hormone agonist suppression protocols for in vitro fertilization in young patients with low body mass index

The key factors affecting cumulative live birth rate after single oocyte retrieved in women during IVF/ICSI-ET: a retrospective analysis of 1380 PCOS patients

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