Ovarian stimulation by concomitant administration of cetrorelix acetate and HMG following Diane-35 pre-treatment for patients with polycystic ovary syndrome: a prospective randomized study

Abstract

The Diane/cetrorelix protocol has a similar pregnancy outcome to the GnRH agonist long protocol for women with PCOS undergoing IVF treatment.

Comparison of embryological and clinical outcome in GnRH antagonist vs. GnRH agonist protocols for in vitro fertilization in PCOS non-obese patients. A prospective randomized study

“…One of them was found in a patient with twin pregnancy and one in a patient with triplet pregnancy. Similar occurrence of ovarian hyperstimulation syndrome in both studied groups was reported by Bahceci et al (5% vs. 7.1%) [38] and Hwang et al (8% vs. 8.3%) [39]. On the contrary, Ashrafi et al [37] reported significantly higher number of PCOS patients at risk of developing OHSS (more than 20 follicles visited in each ovary or E 2 >3,000 pg/ml) in patients in GnRH antagonist arm than GnRH agonist arm of the study (0% vs. 30.4%, p=0.004)…”

“…However, LH level in patients prepared for COH is already decreased with oral contraceptive (OC) on the preceding cycle [39]. Subsequently, according to our results, pulsative LH secretion in GnRH antagonist protocol within the normal physiological range did not have effect on overall outcome.…”

“…Although miscarriage rate in our study did not differ between both studied groups, we observed tendency to higher number of miscarriages in GnRH antagonist than in GnRH agonist group (18% vs. 8%, respectively). Conversely, Hwang et al [39] reported lower percentage of miscarriages in GnRH antagonist group (10% vs. 20%, respectively). Previous studies suggest increased risk of OHSS in women with PCOS [41,42].…”

“…Bahceci et al [38] reported pregnancy rates of 57.6% and 58.5%, implantation rates of 34.0% and 34.6% in GnRH antagonist and agonist arms of the study, respectively. Hwang et al [39] among PCOS patients stimulated with GnRH antagonist and GnRH agonist reported pregnancy rate per started cycle of 37% and 34.5%, respectively. While meta-analyse by Kolibianakis et al suggests that the probability of live birth is not dependent on the type of GnRH analogue used for suppression of premature LH rise/ surge [8], Al-Inany et al [9] showed significant lower the ongoing pregnancy/live-birth rate in the antagonist group.…”

Initiation of GnRH antagonist on Day 1 of stimulation as compared to the long agonist protocol in PCOS patients. A randomized controlled trial: effect on hormonal levels and follicular development

“…Research for alternative GnRH antagonist protocols regarding the timing of its initiation has shifted towards earlier antagonist initiation than Day 6 of stimulation (Elkind-Hirsch et al, 2003;Kolibianakis et al, 2003a;Hwang et al, 2004;Lainas et al, 2005). Support for earlier antagonist initiation was further provided by observations that the exposure to LH and E 2 in the early follicular phase of a GnRH antagonist cycle was negatively associated with the probability of pregnancy (Kolibianakis et al, 2003b).…”