Value of suppression with a gonadotropin‐releasing hormone agonist prior to gonadotropin stimulation for in vitro fertilization

Gonadotropin releasing hormone antagonists suppress aromatase and anti-Müllerian hormone expression in human granulosa cells

“…In our study we investigated the effects of GnRH-ANT on granulosa cells using two cell culture models: [1] primary hGCs obtained from patients undergoing COH during IVF cycles and [2] the HGL5 cell line. The HGL5 cells belong to an immortalized cell line that originated from transformation of luteinized HGCs using HPV 16.…”

“…To date, gonadotropin-releasing hormone (GnRH) analogues are widely used in assisted reproduction to suppress the surge of the endogenous luteinizing hormone (LH) (1,2). GnRH agonists (GnRH-A) and antagonists (GnRH-ANT) have been well characterized to have different mechanisms of action.…”

Management of the poor responder: the role of GnRH agonists and antagonists

“…Five non-randomized series evaluating over 100 women defined as poor responders employing a variety of criteria were treated by administering a GnRHa in the luteal phase and awaiting downregulation prior to initiation of gonadotropins. The patients generally demonstrated improved responses as reflected by enhanced maximal estradiol levels, numbers of oocytes retrieved as well as increased fertilization and pregnancy rates [2][3][4][5][6]. Nevertheless, the gains achieved with this approach were somewhat modest.…”

Different ovarian stimulation protocols for women with diminished ovarian reserve

“…The administration of GnRH-a during the midluteal phase to achieve initial pituitary gonadotropin down-regulation has been used in poor responder patients. Improved oocyte yield and pregnancy rates was found in large nonrandomized series [101][102][103][104] However, McKenna and colleagues [105] reported modest gains from this approach and Horvath and colleagues [106] significantly increased gonadotropin requirements before ovarian stimulation. Although, these data tend to suggest a benefit for the addition of luteal phase GnRH-a in patients who fail to respond to h MG alone, Ashrafi and collegues [107] concluded that there is no advantage in the use of GnRHa compared to the older regimens of clomiphene plus HMG and hMG alone.…”

“…A peak E 2 level of <300 to <500 pg/ml [19] or a level <100 pg/ml have been reported as crucial for defining poor response [22]. A basal (day 3) elevated serum FSH (≥7 to≥15 m IU/ml) is an additional criterion [23][24][25][26]. An advanced patient's age (≥40 years) [26,27], at least one cancelled IVF cycle [28], an increased number of hMG or FSH ampoules used (>44) [29] or increased (>300 IU/day) gonadotropin used [30] and prolonged duration of gonadotropin stimulation [31] have been suggested as more common criteria either alone or in combination.…”