Microdose gonadotropin-releasing hormone agonist in the absence of exogenous gonadotropins is not sufficient to induce multiple follicle development

Chung, Karine; Fogle, R.H.; Bendikson, Kristin; Christenson, Kamilee; Paulson, Richard J.

doi:10.1016/j.fertnstert.2010.07.1081

Cited by 2 publications

(1 citation statement)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Further studies have proven that the hormone profiles consistent with pituitary suppression occurred by day 6 of GnRHa administration. [ 37 ] Thus, as evident in our study, the continued flare effect lasting for the next 24 h with a repeat dose of GnRHa 12 h following the first dose resulted in a better oocyte maturity. This could have been correlated biochemically as well, which is a limiting factor.…”

Section: Discussionsupporting

confidence: 69%

Repeat dose of gonadotropin-releasing hormone agonist trigger in polycystic ovarian syndrome undergoing In Vitro fertilization cycles provides a better cycle outcome - a proof-of-concept study

Krishna¹,

Baiju²,

Gautham³

et al. 2017

J Hum Reprod Sci

View full text Add to dashboard Cite

Objective:Is a single dose of gonadotropin-releasing hormone agonist (GnRHa) trigger to induce final oocyte maturation in polycystic ovarian syndrome (PCOS) undergoing in vitro fertilization (IVF) cycles with GnRH antagonist protocol sufficient to provide optimal oocyte maturity?Design:This is a prospective, randomized, double-blind, proof-of-concept study.Setting:This study was carried out at a tertiary care center.Material and Methods:A total of 125 patients diagnosed with PCOS defined as per the ESHRE/ASRM Rotterdam criteria (2003) undergoing IVF in antagonist protocol were randomized into two groups. Group A: single dose of GnRHa 0.2 mg, 35 h prior to oocyte retrieval, and Group B: 0.2 mg GnRHa 35 h prior to oocyte retrieval + repeat dose of 0.1 mg 12 h following the 1st dose. 12 h post-trigger, luteinizing hormone (LH), progesterone (P4), and follicle-stimulating hormone (FSH) values were estimated.Statistical Analysis:Continuous variables were expressed as mean ± standard deviation and categorical variables as proportions where applicable. Independent sample t-test was used for continuous variables which were normally distributed and Mann–Whitney U-test for data not normally distributed. Chi-square test or Fisher's exact test was used for categorical variables where appropriate. Odds ratio (OR) with 95% confidence intervals (CIs) was calculated. In addition, receiver operating characteristic curve was used to evaluate the post-trigger LH, P4, and FSH values at 12 h as predictors of oocyte maturity.Main Outcome Measures:Primary outcome: maturity rate of the oocytes. Secondary outcomes: oocyte yield, fertilization rate, availability of good quality embryos on day 3, blastocyst conversion, OHSS rates, post-trigger serum LH (IU/L), FSH (IU/L), and P4 (ng/mL) levels implantation rate and clinical pregnancy rate.Results:A higher number of mature (metaphase II) oocytes were obtained in Group B compared to Group A (OR of 0.47; CI: 0.38–0.57; P < 0.01). Significantly a higher number of blastocysts were obtained in Group B than Group A (4.00 vs. 3.04; P = 0.023). The odds of clinical pregnancy per patient were higher in Group B (OR = 0.56; CI [0.27–1.24]), with a trend towards better clinical pregnancy in Group B than in Group A.Conclusions:A repeat dose of GnRHa trigger 12 h following the first dose probably by maintaining a sustained level of gonadotropins yielded a better maturity of oocytes, higher number of blastocysts, and a trend towards higher clinical pregnancy than a single dose in PCOS patients undergoing IVF in antagonist cycles.

show abstract

Section: Discussionsupporting

confidence: 69%

Repeat dose of gonadotropin-releasing hormone agonist trigger in polycystic ovarian syndrome undergoing In Vitro fertilization cycles provides a better cycle outcome - a proof-of-concept study

Krishna¹,

Baiju²,

Gautham³

et al. 2017

J Hum Reprod Sci

View full text Add to dashboard Cite

show abstract

A case report: successful pregnancy after controlled ovarian hyperstimulation by using short-acting gonadotropin releasing hormone agonist only

Gong

Cai

Zhang

et al. 2012

J Assist Reprod Genet

View full text Add to dashboard Cite

Controlled ovarian hyperstimulation (COH) is widely used in in vitro fertilization and embryo transfer (IVF-ET) to achieve multiple follicle development during one treatment cycle. COH is usually initiated by gonadotropin releasing hormone agonist (GnRHa) to down-regulate pituitary secretion of gonadotropins, suppress endogenous LH surge and synchronize multiple follicles development, which is followed by stepwise exogenous gonadotropins stimulation [1,2]. Here we report a case of successful pregnancy after inducing multiple follicles development by using short-acting GnRHa only.A 31-year-old woman, 50 kg weight, was administrated in our unit for four-year primary infertility. Her menstrual cycle was 28 days, lasting 6-7 days. The basal serum follicle-stimulating hormone (FSH), luteinizing hormone (LH) and estradiol (E2) level was 5.1 mIU/mL, 3.56 mIU/mL, and 38.81 pg/mL, respectively. The numbers of antral follicles were eight per ovary.In the mid-luteal phase, the patient was administrated of short-acting GnRHa (Decapeptyl, Ferring, Germany) 0.1 mg/day for pituitary down-regulation] to initiate an IVF treatment cycle. After 14 days administration, the serum FSH was 4.58 mIU/mL, LH was 29.23 mIU/mL, and E2 was 26.79 pg/mL. Transvaginal ultrasound examination showed that there were five follicles with average diameter more than 10 mm, and the largest one was 14 mm. 0.1 mg Decapeptyl was continuously given for one more day and the LH level maintained 29.96 mIU/mL. Then, we decreased the dose of GnRHa to 0.05 mg/day and continuously given for four more days. Ultrasound examination showed five follicles with average diameter more than 20 mm, the largest one was 28 mm. The patients' serum E2 increased to 1,270 pg/mL, LH was 13.51 mIU/mL. 0.05 mg Decapeptyl was continuously given in the morning and 10,000 IU human chorionic gonadotropin (hCG) was administered to trigger egg maturation in the evening. The patient was scheduled for oocyte retrieval 34 h after the hCG injection. Five oocytes were obtained and three fertilized successfully. Two grade I embryos at the 8-cell stage were transferred at d3, and a surplus grade I embryos at the 7-cell stage were frozen. Routine luteum support (UTROGESTAN 200 mg, Bid, Laboratoires Besins-Iscovesco, France) was given after embryo transfer (ET). Serum β-hCG level examined 14 days after ET was 613.9 mIU/mL, indicating a successful biochemical pregnancy. A transvaginal ultrasound examination 4 months after ET confirmed an ongoing intrauterine twin pregnancy. DiscussionIt is widely accepted that high serum LH level in follicular phase will affect the quality of oocytes and ultimately compromise the IVF outcome [3,4], therefore Porter in 1984 [1] firstly introduced the GnRHa into COH to suppress endogenous LH surge. Usually GnRHa firstly induces an augmented pituitary response (flare up effect) followed by

show abstract

Microdose gonadotropin-releasing hormone agonist in the absence of exogenous gonadotropins is not sufficient to induce multiple follicle development

Cited by 2 publications

References 18 publications

Repeat dose of gonadotropin-releasing hormone agonist trigger in polycystic ovarian syndrome undergoing In Vitro fertilization cycles provides a better cycle outcome - a proof-of-concept study

Repeat dose of gonadotropin-releasing hormone agonist trigger in polycystic ovarian syndrome undergoing In Vitro fertilization cycles provides a better cycle outcome - a proof-of-concept study

A case report: successful pregnancy after controlled ovarian hyperstimulation by using short-acting gonadotropin releasing hormone agonist only

Contact Info

Product

Resources

About