Intraindividual Embryo Morphokinetics Are Not Affected by a Switch of the Ovarian Stimulation Protocol Between GnRH Agonist vs. Antagonist Regimens in Consecutive Cycles

Abstract

Background: The impact of controlled ovarian stimulation (COS) during medically assisted reproduction (MAR) on human embryogenesis is still unclear. Therefore, we investigated if early embryonic development is affected by the type of gonadotropin-releasing hormone (GnRH) analog used to prevent a premature LH surge. We compared embryo morphology and morphokinetics between GnRH agonist and antagonist cycles, both involving human chorionic gonadotropin (hCG)-trigger. To reduce possible confounding factors, we used intraindividual comparison of embryo morphokinetics in consecutive treatment cycles of the same patients that underwent a switch in the COS protocol. Methods: This retrospective cohort study analyzed morphokinetics of embryos from patients (n = 49) undergoing a switch in COS protocols between GnRH agonists followed by GnRH antagonists, or vice versa, after culture in a time-lapse incubator (EmbryoScope ® , Vitrolife) in our clinic between 06/2011 and 11/2016 (n = 49 GnRH agonist cycles with n = 172 embryos; n = 49 GnRH antagonist cycles with n = 163 embryos). Among time-lapse cycles we included all embryos of the two consecutive cycles before and after a switch in the type of COS in the same patient. In-vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) was performed and embryos were imaged up to day 5. Data were analyzed using Mann-Whitney U test or Fisher's exact test. The significance level was set to p = 0.05. Patients with preimplantation genetic screening cycles were excluded. Results: The mean age (years ± standard deviation) of patients at the time of treatment was 35.7 ± 4.3 (GnRH agonist) and 35.8 ± 4.0 (GnRH antagonist) (p = 0.94). There was no statistically significant difference in the number of oocytes collected or the fertilization rate. The numbers of top quality embryos (TQE), good-quality embryos (GQE), or poor-quality embryos (PQE) were also not different in GnRH agonist vs. antagonist cycles. Dietrich et al. GnRH Analogs and Embryo Morphokinetics We found no statistically significant difference between the analyzed morphokinetic parameters between the study groups. Conclusions: Our finding supports the flexible use of GnRH analogs to optimize patient treatment for COS without affecting embryo morphokinetics.

Morphokinetic analysis of early human embryonic development and its relationship to endometriosis resection: a retrospective time-lapse study using the KIDScore™ D3 and D5 implantation data algorithm

“…Freis et al were able to show altered embryo morphokinetics in patients with endometriosis compared to non-endometriosis patients, resulting in poorer embryo quality [ 15 , 16 ]. Consistent with our data, they found that it was not the timing of the specific events during early embryo development, but the relative kinetics of the embryo development that changed between the two study groups, with a negative effect for the endometriosis group.…”

“…Inflammatory peritoneal fluid shows a toxic effect on embryos [ 28 ]. This may affect morphokinetic timing, but there is only limited data on morphokinetics and endometriosis [ 15 , 36 ].…”

Ovarian stimulation in assisted reproductive technology cycles for varied patient profiles: An Indian perspective

“…[ 107 ] No difference is noted in embryo morphokinetics within individuals undergoing IVF when switched between antagonist and agonist protocols. [ 108 ]…”

Fixed Gonadotropin-Releasing Hormone Antagonist Protocol Versus Flexible Progestin-Primed Ovarian Stimulation Protocol in Patients With Asynchronous Follicular Development During Controlled Ovulation Stimulation: A Retrospective Study

“…Compared with the shorter learning curve period of the GnRH agonist protocol, that of the antagonist protocol was relatively longer. Numerous studies regarding antagonist protocols focused on the population to whom these protocols could be applied, the success rate of fresh embryo transfer, and the influence of hormone levels on pregnancy outcomes (6)(7)(8). However, only few studies have explored the flexible conversion of antagonist protocols.…”