Evaluation of GnRH antagonist pretreatment before ovarian stimulation in a GnRH antagonist protocol in normal ovulatory women undergoing IVF/ICSI: a randomized controlled trial

Zhang, Yisheng; Liu, Liling; Qin, Jianmin; Huang, Hongyi; Lü, Xue; Wang, Shi-Kai; Tan, Wanlong

doi:10.1186/s12958-021-00836-8

Cited by 5 publications

(5 citation statements)

References 33 publications

(24 reference statements)

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“…The GnRH agonist long-acting protocol is one of the mainstream protocols of COS in China because of its advantages such as effectively improving endometrial receptivity and increasing the clinical pregnancy rate of fresh IVF cycles (4,5). The GnRH antagonist protocol, on the other hand, is widely used because of its shorter duration of stimulation and its association with a low incidence of ovarian hyperstimulation syndrome (OHSS) (5)(6)(7).…”

Section: Introductionmentioning

confidence: 99%

An Individualized Recommendation for Controlled Ovary Stimulation Protocol in Women Who Received the GnRH Agonist Long-Acting Protocol or the GnRH Antagonist Protocol: A Retrospective Cohort Study

et al. 2022

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BackgroundThe GnRH agonist long-acting protocol and GnRH antagonist protocol are widely used in ovarian stimulation. Which protocol eliciting higher live birth rate for IVF/ICSI patients with different ages, different ovarian reserves and different body mass index (BMI) has not been studied. However, among these protocols, the one that elicits higher live birth in IVF/ICSI patients with different ages, ovarian reserves and body mass indexes (BMI) has not been identified.MethodsThis was a retrospective cohort study about 8579 women who underwent the first IVF-ET from January, 2018 to August, 2021. Propensity Score Matching (PSM) was used to improve the comparability between two protocols.ResultsAfter PSM, significant higher live birth rates were found in the GnRH agonist long-acting protocol compared to GnRH antagonist protocol (44.04% vs. 38.32%) (p<0.001). Stratified analysis showed that for those with AMH levels between 3 ng/ml and 6 ng/ml, with BMI ≥ 24 kg/m2 and were aged ≥ 30 years old, and for those women with BMI < 24kg/m2 and were aged ≥30 years whose AMH levels were ≤ 3ng/ml, the GnRH agonist long-acting protocol was more likely to elicit live births [OR (95%CI), 2.13(1.19,3.80)], [OR (95%CI), 1.41(1.05,1.91)]. However, among women with BMI ≥ 24kg/m2 and were aged ≥30 years whose AMH levels were ≤ 3ng/ml, the GnRH agonist long-acting protocol had a lower possibility of eliciting live births [OR (95%CI), 0.54(0.32,0.90)]. Also, among women with AMH levels between 3 ng/ml and 6 ng/ml, with BMI ≥ 24 kg/m2 and with age < 30 years and for those with AMH levels between 3 ng/ml and 6 ng/ml, regardless of age, and with BMI<24kg/m2,, the possibility of live births was similar between the two protocols [OR (95%CI), 1.06(0.60,1.89)], [OR (95%CI), 1.38(0.97,1.97)], [OR (95%CI), 0.99(0.72,1.37)]. Among the women with AMH levels ≤ 3 ng/ml and with were aged < 30years, regardless of BMI, the possibility of live birth was similar between the two protocols [OR (95%CI), 1.02(0.68,1.54)], [OR (95%CI), 1.43(0.68,2.98)]. Moreover, among women with AMH levels ≥ 6ng/ml, the possibility of live birth was similar between the two protocols [OR (95%CI),1.42(0.75,2.69)], [OR (95%CI),1.02(0.19,5.35)], [OR (95%CI), 1.68(0.81,3.51)], [OR (95%CI), 0.51(0.10,2.55)].ConclusionsThe suitability of the GnRH agonist long-acting protocol or GnRH antagonist protocol to infertility patients is dependent on specific biological characteristics of the patients.

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Section: Introductionmentioning

confidence: 99%

An Individualized Recommendation for Controlled Ovary Stimulation Protocol in Women Who Received the GnRH Agonist Long-Acting Protocol or the GnRH Antagonist Protocol: A Retrospective Cohort Study

et al. 2022

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“…A randomized controlled trial (RCT) involving 69 patients by Blockeel C [12] also showed that 3-day antagonist pretreatment followed by ovulation stimulation during menstruation increased the number of retrieved oocytes but did not improve the rate of ongoing pregnancy. Our team's RCT research [4] showed an increased sample size but found no improvement in the number of retrieved oocytes or the pregnancy rate in regular ovarian responders.…”

Section: Discussionmentioning

confidence: 86%

“…Protocols [4] In the conventional antagonist protocol (control group), ovarian stimulation with Gn was initiated on day 2 of the menstrual cycle (C2). In the pretreatment GnRH-ant protocol (study group), ovarian stimulation was performed after three days (C5) of GnRH-ant pretreatment (Cetrotide®, 0.25 mg cetrorelix acetate, Serono, Inc.).…”

Section: Inclusion Criteria and Exclusion Criteriamentioning

confidence: 99%

Evaluation of GnRH antagonist pretreatment before ovarian stimulation in a GnRH antagonist protocol in women with poor ovarian response undergoing IVF/ICSI: A retrospective propensity-score-matching study

Zhang

Qin

et al. 2023

Preprint

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Backgroud: A low number of retrieved oocytes significantly affects the clinical pregnancy rate (CLR) in patients with a poor ovarian response (POR).The aim of this study was to assess the effect of GnRH antagonist（GnRH-ant） pretreatment performed on days 2 to 4 of the menstrual cycle on pregnancy outcomes in women with POR undergoing in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI). Methods: We conducted a retrospective study of 208 women with POR undergoing IVF/ICSI from January 2018 to August 2021. The pretreatment GnRH-ant protocol (study group) comprised 32 patients, and the conventional antagonist protocol (control group) included 176 patients. A propensity-score-matching (PSM) method using nearest neighbour matching at a proportion of 1:3 was performed. After PSM, we compared the pregnancy outcomes of each group. Results: After PSM, there was no significant difference in age, antral follicle count (AFC), AMH level, or gonadotropin (Gn) level between the two groups (P>0.5). There were no significant differences in the number of retrieved oocytes, mature oocytes, normally fertilized oocytes, transferable embryos, and good-quality embryos between the two groups (P>0.05). There were no significant differences in biochemical and clinical pregnancy rates between the two groups (P>0.05). The implantation rate [34.4% (11/32)] and live birth rate [50.0% (8/16)] of the studygroup were higher than those of the control group [15.5% (9/58), P=0.039; 13.8% (4/29), P=0.014]. Conclusions: Treatment with a GnRH antagonist on day 2 to day 4 of the menstrual cycle did not increase the number of retrieved oocytes or the clinical pregnancy rate in women with POR undergoing IVF/ICSI, but it may increase the live birth rate. Trial registration: Chinese Clinical Trial Registry, ChiCTR1800019730.

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“…GnRH antagonist administration in the early follicular phase can decrease gonadotrophin levels, which may improve synchronization of follicles, improving ovulation stimulation (50). Maged et al in 2015 compared a delayed start protocol with a standard protocol that used a gonadotropin releasing hormone antagonist (GnRH antagonist) in poor responding patients (51).…”

Section: Gonadotropin Releasing Hormone (Gnrh)mentioning

confidence: 99%

Researching the Phenomenon of Poor Ovarian Responders and Management Strategies in IVF: A Narrative Review

Galatis

Kalopita

Grypiotis

et al. 2022

ama

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This narrative review aims to summarize all the latest studies published between 2015-2021 concerning the management protocols adopted for poor ovarian response (POR) cases. Patients defined as “poor responders” show minimal response to controlled ovarian hyperstimulation, although there is no standard definition for POR. Although infertility specialists are endeavoring to improve cycle outcomes in poor responders by adopting multiple management strategies, still the estimated risk of cycle cancellation is about 20%. All the studies performed during this study period were evaluated and their results were recorded. The latest published protocols to improve oocyte retrieval in poor responders include: anti-Mϋllerian hormone, clomiphene citrate, co-enzyme Q10, corifollitropin, dehydroepiandrosterone, double stimulation, Follicle Stimulation Hormone, Growth Hormone, Gonadotropin-releasing hormone agonists, letrozole, human chorionic gonadotropin, Luteinizing Hormone, progesterone and testosterone. Conclusion. Although many strategies have been suggested to manage POR, none has been proven superior to the others. Further large-scale randomized studies are needed to validate experimental techniques leading towards successful individualized treatment regimens.

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Evaluation of GnRH antagonist pretreatment before ovarian stimulation in a GnRH antagonist protocol in normal ovulatory women undergoing IVF/ICSI: a randomized controlled trial

Cited by 5 publications

References 33 publications

An Individualized Recommendation for Controlled Ovary Stimulation Protocol in Women Who Received the GnRH Agonist Long-Acting Protocol or the GnRH Antagonist Protocol: A Retrospective Cohort Study

An Individualized Recommendation for Controlled Ovary Stimulation Protocol in Women Who Received the GnRH Agonist Long-Acting Protocol or the GnRH Antagonist Protocol: A Retrospective Cohort Study

Evaluation of GnRH antagonist pretreatment before ovarian stimulation in a GnRH antagonist protocol in women with poor ovarian response undergoing IVF/ICSI: A retrospective propensity-score-matching study

Researching the Phenomenon of Poor Ovarian Responders and Management Strategies in IVF: A Narrative Review

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