Efficacy and safety of ganirelix acetate versus leuprolide acetate in women undergoing controlled ovarian hyperstimulation

Purpose To explore the optimal timing for hCG triggering by investigating the impact of different proportion of dominant follicles on the oocyte developmental competence. Methods One hundred ninety-eight infertile women were divided into three groups according to the proportion of dominant follicles on hCG day: (1) low: <15 % (n=66); (2) middle: 15-27 % (n=66); (3) high: >27 % (n=66). The grouping criteria were the bottom and top tertiles of the proportion of dominant follicles. Results The gonadotropin dosage, duration and maximum follicle diameter in the low proportion group were lower than those in the middle and high proportion groups. Oocyte maturation and the abnormal fertilization rate in the low proportion group were lower than those in the middle and high proportion groups. The normal fertilization rate did not differ among the three groups. The cleavage rate and number of transferable embryos in the low proportion group were significantly higher than those in the high proportion group. The high-quality embryo rate, implantation rate, and pregnancy rate in the low proportion group were significantly higher than those in the middle and high proportion groups.Conclusions A high proportion of dominant follicles are closely associated with impaired oocyte developmental competence and low pregnancy rate. These findings suggest that follicular overgrowth induced by delayed hCG triggering may undermine oocyte developmental competence and the proportion of dominant follicles may be a potential parameters for hCG triggering.

Section: Introductionmentioning

confidence: 99%

Association between the proportion of dominant follicles and oocyte developmental competence

et al. 2014

“…Results of clinical trials to date suggest that, with gonadotropin releasing hormone (GnRH)-antagonists for pituitary down-regulation, much shorter treatment regimens with fewer injections and possibly less gonadotropin can achieve good clinical results [1][2][3]. However, even accomplishing similar estradiol levels, ovarian stimulation cycles using GnRH-antagonists down-regulation during in vitro fertilization/intra-cytoplasmic sperm injection (IVF/ICSI) cycles have been reported to have worse pregnancy outcomes when compared to GnRH-agonists [4].…”

Section: Introductionmentioning

confidence: 99%

“…The FDA-approved GnRH-antagonist daily dose for pituitary down-regulation has been set at 0.25 mg subcutaneous injection [1,2]. The simplest way for physicians to adjust the amount of medication given, and to potentially prevent its direct detrimental effects, is to vary the duration of administration.…”

Section: Introductionmentioning

confidence: 99%

Timing and duration of use of GnRH antagonist down-regulation for IVF/ICSI cycles have no impact on oocyte quality or pregnancy outcomes

Detti

Ambler

Yelian

et al. 2008

Purpose To evaluate whether oocyte quality, implantation and pregnancy outcomes in in vitro fertilization (IVF)/ intra-cytoplasmic sperm injection (ICSI) are related to the duration of gonadotropin-releasing hormone (GnRH)-antagonist use or the timing of its initiation. Methods Retrospective cohort study of 178 conventional IVF/ICSI cycles. All patients underwent ovarian stimulation with gonadotropins and GnRH-antagonist for pituitary down-regulation. Spearman correlations and logistic regression were used for statistical analysis. Results There was no correlation between the duration of use or the timing of initiation of GnRH-antagonist with oocyte quality or implantation and pregnancy outcomes. Oocyte quality was influenced by the peak estradiol. Implantation was influenced by the patient's age. Early pregnancy loss, by the endometrial thickness on human chorionic gonadotropin-day. Ongoing pregnancy was independent from the variables evaluated.Conclusions GnRH-antagonist duration of use or starting day did not influence oocyte quality, implantation rates, and pregnancy rates. We hypothesize that a follicle stimulating hormone/luteinizing hormone dose increase when antagonist was started, may have had an impact on our findings.

“…This could be possibly due to the differences in the criteria used for inducing final oocyte maturation. In our study, hCG was administered as soon as at least three follicles were ≥16 mm on ultrasound, while in most other studies, triggering of final oocyte maturation is performed in the presence of at least three follicles with a maximum diameter of ≥17 mm (17)(18)(19)(20) or ≥18 mm (21).…”

Section: Discussionmentioning

confidence: 99%

Optimized Hormonal Stimulation Is Critical for Production of Viable Embryos and Establishment of Subsequent Implantation

Tao

Robichaud

Nadeau

et al. 2006

Purpose : To investigate the effects of follicle number and size at the time of hCG administration, and ovarian stimulation length on the outcome of in vitro fertilization and pregnancy rate. Methods : During the ovarian stimulation regimen, the follicular number and size were determined by transvaginal ultrasonographic examination. Ovulation was induced as early as three or more follicles were at least 16 mm in their greatest diameter. Results : The fertilization rates were significantly increased with the longer length of stimulation (10-12 days: 75.4% and 13-16 days: 83.2%). However, no significant differences in the chemical pregnancy, clinical pregnancy, and implantation rates were found between 10-12 days (53.7%, 43.9%, and 21.8%) and 13-16 days (50.0%, 43.8%, and 23.4%) of stimulation. There were no significant differences in fertilization and chemical pregnancy rates between two groups with ≥ and <18 follicles in the ovaries on the day of hCG (human chorionic gonadotrophin) administration. However, the clinical pregnancy and implantation rates (47.2% and 26.0%) in the group with <18 follicles were significantly higher than those (33.3% and 15.5%) in the group with ≥18 follicles, respectively. Conclusions : Excessive and rapid ovarian stimulation appears to decrease the survival of embryos at later stages after transfer. The advantage of prolonged stimulation may outweigh the potential adverse effects in some patients.