The luteal phase and early pregnancy after combined GnRH-agonist/HMG treatment for superovulation in IVF or GIFT

Smitz, Johan; Devroey, Paul; Camus, Michel; Deschacht, J.; Khan, Iqbal; Staessen, Cathérine; Waesberghe, L. Van; Wisanto, A.; Steirteghem, A.C. Van

doi:10.1093/oxfordjournals.humrep.a136750

Cited by 191 publications

(74 citation statements)

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“…In unsuccessful cycles, the late luteal E2 levels decline which may compromise periimplantation endometrial developments [24]. Vlahose et al found that the addition of Estrogen to P in the luteal phase can increase L-selectin ligands -adhesion molecule in the endometrium during implantation [25].…”

Section: Discussionmentioning

confidence: 99%

Estradiol supplementation during the luteal phase in poor responder patients undergoing in vitro fertilization: a randomized clinical trial

Aghahosseini

Aleyassin

Khodaverdi

et al. 2011

J Assist Reprod Genet

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Purpose This study was designed to evaluate the effects of adding Estradiol (E2) supplementation to progesterone (P) on improvement of pregnancy outcomes in poor responder patients who underwent in vitro fertilization (IVF).Methods In a prospective randomized clinical trial, 118 poor responder patients, older than 38 years without contraindications of estradiol consumption from Infertility clinic of a university hospital were randomly divided (by computerized software) into two groups. Control group (59 patients) received only P and intervention group (59 patients) received P and E2 (4 mg/d). Supplementation was done with 4 mg E2 in the luteal phase. Fertilization rate, implantation rate, biochemical and clinical pregnancy rates, abortion rate, ongoing pregnancy, multiple pregnancy and ectopic pregnancy rates were documented for those who completed the study protocol in each group (per protocol analysis) and compared between groups. Result Fifty five patients in control group and 53 patients in intervention group successfully completed the study protocol. Treatment outcomes were not significantly different between two groups. Conclusion For poor responder women who underwent IVF, addition of E2 to P supplementation could not significantly improve pregnancy outcomes.

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Section: Discussionmentioning

confidence: 99%

Estradiol supplementation during the luteal phase in poor responder patients undergoing in vitro fertilization: a randomized clinical trial

Aghahosseini

Aleyassin

Khodaverdi

et al. 2011

J Assist Reprod Genet

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“…Through the early 1980s, GnRH1a was applied to prevent the LH surge during ovarian stimulation (9). By the end of the decade, the so-called long downregulation protocol with GnRH1a was established IVF practice, significantly reducing the rate of cycle cancellation, improving outcomes and enabling some flexibility to schedule oocyte retrieval (10). (Fig.…”

Section: Historical Perspectivementioning

confidence: 99%

GnRH analogues: applications in assisted reproductive techniques

Hayden

2008

European Journal of Endocrinology

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The ability to prevent an endogenous LH surge revolutionised the efficacy of assisted reproductive techniques (ART) such that GnRH agonists were rapidly adopted in the 1980s. Prior to this, premature luteinisation occurred in up to 25% of superovulated cycles leading to cycle cancellation and severely compromised outcomes. Analogues have been applied in a variety of drug protocols (long, short flare) but there has been little research to moderate the degree of pituitary suppression. There has also been ongoing and unresolved debate about the role of LH in supporting follicular development.By 2001, the first GnRH antagonists were registered for use in ART. Their ability to cause immediate suppression of gonadotrophin (particularly LH) secretion means that they can be given after exogenous stimulation has begun and thereby dramatically shorten the total duration of a treatment cycle. After initial enthusiasm and then scepticism that pregnancy rates may not be as high as the established agonist regimens, these preparations are now being increasingly adopted with at least comparable outcomes in large trials. They are certainly favoured by patients for their reduced side-effect profile and particularly for the shortening of the total cycle length. This shift in practice is occurring alongside gathering momentum in favour of milder stimulation protocols and a new perception of what constitutes successful treatment. The focus is moving away from surrogate outcomes such as oocyte numbers and conception rates towards long-term outcomes for women and their offspring, namely the achievement of a live singleton birth per treatment started.

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“…However, some studies claim that using hCG and progesterone support increases implantation and pregnancy rates [15,16]. Smitz et al [17] first reported that in COH cycles, estradiol levels decreased in the late luteal phase and in the early gestational weeks. Parallel to this, progesterone and 17-OH-progesterone levels were also decreased.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Pregnancy Outcomes of Progesterone or Progesterone + Estradiol for Luteal Phase Support in ICSI-ET Cycles

Görkemli

Akyürek

et al. 2004

Gynecol Obstet Invest

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Objective: To find out the effect of estradiol with progesterone for luteal phase support in IVF-ICSI cycles. Materials and Methods: Patients were accepted for treatment in the ART unit of Selcuk University, Meram Faculty of Medicine, between January 2001 and March 2003. The study was done in a prospective manner. The age range of 252 women was 19–41 years and the total number of cycles was 310. All patients were treated with a long ovulation induction protocol. Patients were treated and divided into two groups in a randomized manner: group I used only 600 mg/day divided into three equal doses of micronized progesterone vaginally, and group II used transdermal estradiol 100 µg/day + 600 mg/day vaginal micronized progesterone. Results: 310 ICSI cycles were carried out in 252 infertile couples between January 2001 and March 2003. From 22 of these cycles, oocytes were retrieved but no embryos were developed. In the remaining 288 cycles there were embryo transfers. All embryo development was achieved by ICSI treatment. In 148 out of 288 cycles, the luteal phase was supported only by vaginal micronized progesterone (group I). On the other hand, the remaining 140 cycles received vaginal micronized progesterone plus transdermal estradiol 100 µg/day (group II). The number of β-hCG-positive results in group I and group II were 20 (13.5 %) and 54 (38.5%) respectively. Conclusion: Adding estradiol to progesterone for luteal phase support in ICSI-ET cycles may increase implantation and pregnancy rates.

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The luteal phase and early pregnancy after combined GnRH-agonist/HMG treatment for superovulation in IVF or GIFT

Cited by 191 publications

References 0 publications

Estradiol supplementation during the luteal phase in poor responder patients undergoing in vitro fertilization: a randomized clinical trial

Estradiol supplementation during the luteal phase in poor responder patients undergoing in vitro fertilization: a randomized clinical trial

GnRH analogues: applications in assisted reproductive techniques

Comparison of Pregnancy Outcomes of Progesterone or Progesterone + Estradiol for Luteal Phase Support in ICSI-ET Cycles

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