Gn-RH antagonists in intrauterine insemination: the weekend-free protocol

Abstract

Objective:To compare the results of intrauterine insemination (IUI) when GnRH antagonist was added-to avoid IUI on weekend-with those obtained with the standard IUI protocol. Study design:In an IUI program under ovarian stimulation with gonadotropins when one or more follicles of 15-16 mm were seen, if it was not possible for logistic reasons (weekend) to perform the insemination 72 h later, GnRH antagonist was administered until human chorionic gonadotropin (hCG) administration. The IUI was performed on Monday. We compared the results of this IUI "weekend-free" group with our results in standard IUI cycles, where IUI was performed 36-38 h after reaching optimal follicular growth. Results: Both groups were comparable regarding the main demographic parameters, except for higher estradiol levels, due to the prolonging ovarian stimulation. The per cycle pregnancy rate (PR) were very similar in both groups: 15.7% in the weekend-free IUI versus 16.5% in standard IUI. The multiple pregnancy rate and the hyperstimulation rate were also similar. A non-significant trend to higher high-order multiple pregnancy was observed in the weekendfree IUI. Conclusions: In IUI cycles under ovarian suprastimulation with gonadotrophins, the use of GnRH antagonist allows the manipulation of the follicular development in such a way that it is possible to avoid inseminations on the weekends, without apparently reducing the PR.

Effects and clinical significance of GnRH antagonist administration for IUI timing in FSH superovulated cycles: a meta-analysis

“…All of the other RCTs reported that multiple pregnancies observed were only twins. The retrospective study (8) reported equal number of high-order multiple pregnancies in both groups.…”

“…Also an analysis that included the retrospective trial of Matorras et al (8) was performed. Data extraction was performed independently by two investigators ,and conflicts were solved after discussion.…”

“…The third study that was excluded was a review (1). Another study (8), although addressing our question, was retrospective and was not included (Fig. 1).…”

Effect of GnRH antagonists on clinical pregnancy rates in ovulation induction protocols with gonadotropins and intrauterine insemination

“…(23,24) The use of GnRH antagonists has also been shown to be effective in manipulating follicular development, so that the insemination process can be suspended on weekends without an apparent decrease in pregnancy rates. (25,26) The present study was not without limitations. The number of women enrolled in the study small; nevertheless, other studies investigating the same subject have also enrolled small numbers of patients.…”

THE USE OF GnRH ANTAGONISTS IN OVARIAN STIMULATION FOR INTRAUTERINE INSEMINATION

“…Apart from a particular subgroup of patients, routine application of antagonists will only increase the cost treatment without any effect on pregnancy rate. ESHRE Capri Workshop also stated discharges and therefore fail to complete treatment; * cycles initiated with the intention to proceed to IUI but switched to ART; * when one or more follicles measure ≥14 mm and the probable day of insemination coincide weekend; in order to skip the weekend for logistic reasons or the lack of on call staff (31) and * To decrease the frequency of sonography examinations and blood hormone measurements and related clinical task burden.…”