Meta-analysis of GnRH-antagonists versus GnRH-agonists in poor responder protocols

Papamentzelopoulou, Myrto; Stavros, Sofoklis; Mavrogianni, Despoina; Kalantzis, Christos; Loutradis, Dimitrios; Drakakis, P.

doi:10.1007/s00404-020-05954-z

Cited by 8 publications

(13 citation statements)

References 40 publications

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“…It inhibits the secretion of gonadotropin within a few hours and avoids excessive pituitary inhibition. Therefore, GnRH-ant can effectively reduce the consumption of gonadotropin and greatly shorten the treatment time ( 11 , 12 ). The results of the present study suggested that the duration of stimulation and the dosage of gonadotropins of GnRH-ant group were significantly lower than those of GnRH-a group, which was consistent with the previous studies ( 6 , 13 ).…”

Section: Discussionmentioning

confidence: 99%

GnRH Antagonist Protocol Versus GnRH Agonist Long Protocol: A Retrospective Cohort Study on Clinical Outcomes and Maternal-Neonatal Safety

Zhu

Xing

et al. 2022

Front. Endocrinol.

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ObjectiveTo evaluate the clinical outcomes and maternal-neonatal safety of gonadotropin releasing hormone antagonist (GnRH-ant) and gonadotropin releasing hormone agonist (GnRH-a) protocols.MethodsA total of 2505 women undergoing their first in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) were retrospectively analyzed. Patients were divided into GnRH-ant group (n = 1514) and GnRH-a group (n = 991) according their stimulation protocol. Propensity Score Matching (PSM) was used for balancing the baseline of two groups. The pregnancy outcomes were analyzed in fresh transfer cycles, and the obstetric and perinatal outcomes were calculated in singleton live births of fresh cycles. The primary outcome was the live birth rate. The secondary outcome measures were maternal complications, preterm birth rate, low birthweight rate, multiple pregnancy rate, and moderate-severe OHSS rate.ResultsAfter 1:1 PSM, baseline characteristics of the GnRH-ant group and GnRH-a group were matched and assigned 991 cycles in each group. Before PSM, there were 700 fresh cycles including 237 singleton live births in the GnRH-ant group and 588 fresh cycles including 187 singleton live births in the GnRH-a group. After PSM, there were 471 fresh cycles including 166 singleton live births in the GnRH-ant group and 588 fresh cycles including 187 singleton live births in the GnRH-a group. No significant differences were observed in the live birth rate (44.6% vs 48.8%), maternal complications, preterm birth rate (9.0% vs 6.4%), and low birthweight rate (17.5% vs 24.1%) between two groups after PSM (P > 0.05). The moderate-severe OHSS rate (2.9% vs 6.0%, P = 0.002) and multiple pregnancy rate (24.5% vs 33.1%, P = 0.025) was significantly lower in the GnRH-ant group than that in the GnRH-a group after PSM.ConclusionGnRH-ant protocol was comparable with GnRH-a protocol in clinical outcomes, obstetric and perinatal outcomes, and with a lower risk of OHSS. For those who want to get an effective and safe outcome, and a shorter treatment period, GnRH-ant is a suitable choice.

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Section: Discussionmentioning

confidence: 99%

GnRH Antagonist Protocol Versus GnRH Agonist Long Protocol: A Retrospective Cohort Study on Clinical Outcomes and Maternal-Neonatal Safety

Zhu

Xing

et al. 2022

Front. Endocrinol.

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“…Published data compared various protocols in DOR patients, GnRH agonist protocol and modified natural cycle were thought to be more effective than other protocols, since they could improve the quality of oocytes and probability of live birth of women with DOR ( 20 , 21 ). The latest meta-analysis does not promote GnRH antagonist protocol for DOR patients because it correlates with higher cancellation rates and less pregnancies compared to agonist protocols ( 22 ). Ovarian stimulation protocol choice should be based on physical condition of DOR patients, which may be different each cycle.…”

Section: Discussionmentioning

confidence: 99%

Which Factors Are Associated With Reproductive Outcomes of DOR Patients in ART Cycles: An Eight-Year Retrospective Study

Sun

Wang

et al. 2022

Front. Endocrinol.

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IntroductionWomen with diminished ovarian reserve (DOR) have a lower pregnancy rate and higher cancellation rate compared to those without DOR when seeking assisted reproductive technology. However, which factors are associated with reproductive outcomes and whether AMH is a predictor of clinical pregnancy remain unclear.ObjectiveThis retrospective study was designed to find factors associated with reproductive outcomes in DOR patients and then discuss the role of AMH in predicting cycle results among this population.MethodA total of 900 women were included in the study. They were diagnosed with DOR with the following criteria: (i) FSH > 10 IU/L; (ii)AMH < 1.1 ng/ml; and (iii) AFC <7. They were divided into different groups: firstly, based on whether they were clinically pregnant or not, pregnant group vs. non-pregnant group (comparison 1); secondly, if patients had transferrable embryos (TE) or not, TE vs. no TE group (comparison 2); thirdly, patients undergoing embryo transfer (ET) cycles were divided into pregnant I and non-pregnant I group (comparison 3). The baseline and ovarian stimulation characteristics of these women in their first IVF/ICSI cycles were analyzed. Logistic regression was performed to find factors associated with clinical pregnancy.ResultsOf the 900 DOR patients, 138 women got pregnant in their first IVF/ICSI cycles while the rest did not. AMH was an independent predictor of TE after adjusting for confounding factors (adjusted OR:11.848, 95% CI: 6.21-22.62, P< 0.001). Further ROC (receiver operating characteristic) analysis was performed and the corresponding AUC (the area under the curve) was 0.679 (95% CI: 0.639-0.72, P< 0.001). Notably, an AMH level of 0.355 had a sensitivity of 62.6% and specificity of 65.6%. However, there was no statistical difference in AMH level in comparison 3, and multivariate logistic regression showed female age was associated with clinical pregnancy in ET cycles and women who were under 35 years old were more likely to be pregnant compared to those older than 40 years old (adjusted OR:4.755, 95% CI: 2.81-8.04, P< 0.001).ConclusionAMH is highly related to oocyte collection rate and TE rate,and 0.355 ng/ml was a cutoff value for the prediction of TE. For DOR patients who had an embryo transferred, AMH is not associated with clinical pregnancy while female age is an independent risk factor for it.

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“…A meta-analysis conducted by Papamentzelopoulou M. et al, 24 revealed that GnRH antagonist protocols have a shorter duration of ovarian stimulation, whereas GnRHagonist protocols have fewer cycle cancellation rates, more embryos transferred, and more clinical pregnancies.…”

Section: Discussionmentioning

confidence: 99%

“…A meta-analysis conducted by Papamentzelopoulou M. et al, 24 revealed that GnRH antagonist protocols have a shorter duration of ovarian stimulation, whereas GnRH-agonist protocols have fewer cycle cancellation rates, more embryos transferred, and more clinical pregnancies. In a previous meta-analysis of fourteen studies conducted by Danhua Pu and his colleagues, 22 a shorter duration of stimulation with GnRH antagonists was also observed.…”

Section: Discussionmentioning

confidence: 99%

Comparison of two ovarian stimulation protocols among women with poor response: A randomized clinical trial

Bavarsadkarimi

Omidi²,

Shahmoradi

et al. 2022

Eur J Transl Myol

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This is a randomized controlled trial conducted in a tertiary referral fertility department. Participants were women with previous poor ovarian response undergoing in vitro fertilization. (IVF). One hundred and ninety-two women were randomized to the short GnRH agonist and antagonist regimens. The primary outcome was the number of oocytes retrieved. Secondary outcome measures were the number of embryos transferred, chemical and clinical pregnancy rate and live birth. The number of oocytes retrieved was higher with the gonadotrophin-releasing hormone (GnRH) antagonist regimen compared to the short agonist regimen (3.10 2.70 vs. 2.992.60), but there was no significant difference. The duration of stimulation and total gonadotropin dose were higher with short agonist regimens compared to antagonist regimens, with the latter being statistically significant (p < 0.001). The chemical pregnancy rate was 8.33 percent with the short agonist regimen and 7.29 percent with the antagonist regimen, with no statistically significant difference (p = 0.79). In terms of lower cycles cancelation and higher chemical pregnancy, short GnRH agonist regim is appropriate choice for poor responders.

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Meta-analysis of GnRH-antagonists versus GnRH-agonists in poor responder protocols

Cited by 8 publications

References 40 publications

GnRH Antagonist Protocol Versus GnRH Agonist Long Protocol: A Retrospective Cohort Study on Clinical Outcomes and Maternal-Neonatal Safety

GnRH Antagonist Protocol Versus GnRH Agonist Long Protocol: A Retrospective Cohort Study on Clinical Outcomes and Maternal-Neonatal Safety

Which Factors Are Associated With Reproductive Outcomes of DOR Patients in ART Cycles: An Eight-Year Retrospective Study

Comparison of two ovarian stimulation protocols among women with poor response: A randomized clinical trial

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