Volume 14, Issue 12 (12-2016)                   IJRM 2016, 14(12): 769-776 | Back to browse issues page


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Nikmard F, Aflatoonian B, Hosseini E, Aflatoonian A, Bakhtiyari M, Aflatoonian R. A comparative study on the results of agonist and antagonist protocols based on serum AMH levels in patients undergoing intracytoplasmic sperm injection. IJRM 2016; 14 (12) :769-776
URL: http://ijrm.ir/article-1-712-en.html
1- Anatomy Department, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
2- Stem Cell Biology Research Center, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
3- Department of Obstetrics and Gynecology, Research and Clinical Center for Infertility, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
4- Anatomy Department, School of Medicine, Iran University of Medical Sciences, Tehran, Iran , Mehr_bakhtiyari@gmail.com
5- Department of Endocrinology and Female Infertility at Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
Abstract:   (2754 Views)
Background: Serum concentrations of antimullerian hormone (AMH) correlate with ovarian response during assisted reproduction treatment (ART) cycles.
Objective: This retrospective study attempted to evaluate the selection of ovarian stimulation protocols based on serum AMH levels in patients and its impact on the results of ART.
Materials and Methods: Based on AMH levels, the patients with tubal factor infertility were divided in three groups of normal, low and high AMH levels. Oocyte, good embryo number and pregnancy rate in each group were analyzed.
Results: Using agonist and antagonist protocols, an increase in serum AMH led to higher number of oocytes and better quality embryos. At all low, normal and high AMH levels, the agonist protocol led to a more significant increase in the number of oocytes than the antagonist protocol (p<0.05). The number of high quality embryos significantly increased by the agonist protocol than antagonist protocol in women with normal AMH levels of 1.3-2.6 ng/ml (p=0.00). Moreover, the results for the number of high quality embryos at AMH ˃2.6 ng/ml was in favor of the antagonist protocol (p=0.00). The results showed the lowest pregnancy rate at AMH ˂1.3 ng/ml. At AMH ˃2.6 ng/ml, there was a significant increase in pregnancy rate through the antagonist protocol (p=0.04).
Conclusion: Findings of this study suggested that the ART results are predictable, taking into account the AMH levels. The protocol specific to each patient can be used given the AMH level in each individual. This is because the results of each protocol depend on individual conditions
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Type of Study: Original Article |

References
1. Mochtar MH. The effect of an individualized GnRH antagonist protocol on folliculogenesis in IVF/ICSI. Hum Reprod 2004; 19: 1713-1718. [DOI:10.1093/humrep/deh334]
2. Depalo R, Lorusso F, Palmisano M, Bassi E, Totaro I, Vacca M, et al. Follicular growth and oocyte maturation in GnRH agonist and antagonist protocols for in vitro fertilisation and embryo transfer. Gynecol Endocrinol 2009; 25: 328-334. [DOI:10.1080/09513590802617762]
3. Greco E, Litwicka K, Ferrero S, Baroni E, Sapienza F, Rienzi L, et al. GnRH antagonists in ovarian stimulation for ICSI with oocyte restriction: a matched, controlled study. Reprod Biomed Online 2007; 14: 572-578. [DOI:10.1016/S1472-6483(10)61048-6]
4. Hoseini FS, Noori Mugahi SM, Akbari-Asbagh F, Eftekhari-Yazdi P, Aflatoonian B, Aghaee-Bakhtiari SH, et al. A randomized controlled trial of gonadotropin releasing hormone agonist versus gonadotropin-releasing hormone antagonist in Iranian infertile couples: oocyte gene expression. Daru 2014; 22: 67-76. [DOI:10.1186/s40199-014-0067-4]
5. Aflatoonian A, Oskouian H, Ahmadi SH, Oskouian L. Prediction of high ovarian response to controlled ovarian hyperstimulation: anti-Müllerian hormone versus small antral follicle count (2-6 mm). J Assist Reprod Genet 2009; 26: 319-325. [DOI:10.1007/s10815-009-9319-5]
6. Durlinger AL, Visser JA, Themmen AP. Regulation of ovarian function: the role of anti-Müllerian hormone. Reproduction 2002; 124: 601-609. [DOI:10.1530/rep.0.1240601]
7. Durlinger AL, Gruijters MJ, Kramer P, Karels B, Kumar TR, Matzuk MM, et al. Anti-Müllerian hormone attenuates the effects of FSH on follicle development in the mouse ovary. Endocrinology 2001; 142: 4891-4899. [DOI:10.1210/endo.142.11.8486]
8. Gruijters MJ, Visser JA, Durlinger AL, Themmen AP. Anti-Müllerian hormone and its role in ovarian function. Mol Cell Endocrinol 2003; 211: 85-90. [DOI:10.1016/j.mce.2003.09.024]
9. Cook CL, Siow Y, Taylor S, Fallat ME. Serum müllerian-inhibiting substance levels during normal menstrual cycles. Fertil Steril 2000; 73: 859-861. [DOI:10.1016/S0015-0282(99)00639-1]
10. Hehenkamp WJ, Looman CW, Themmen AP, de Jong FH, Te Velde ER, Broekmans FJ. Anti-Müllerian hormone levels in the spontaneous menstrual cycle do not show substantial fluctuation. J Clin Endocrinol Metab 2006; 91: 4057-4063. [DOI:10.1210/jc.2006-0331]
11. Nelson SM, Yates RW, Fleming R. Serum anti-Mu¨ llerian hormone and FSH: prediction of live birth and extremes of response in stimulated cycles-implications for individualization of therapy. Hum Reprod 2007; 22: 2414-2421. [DOI:10.1093/humrep/dem204]
12. Majumder K, Gelbaya TA, Laing I, Nardo LG. The use of anti-Müllerian hormone and antral follicle count to predict the potential of oocytes and embryos. Eur J Obstet Gynecol Reprod Biol 2010; 150: 166-170. [DOI:10.1016/j.ejogrb.2010.02.029]
13. Yates AP, Rustamov O, Roberts SA, Lim HY, Pemberton PW, Smith A, et al. Anti-Mullerian hormone-tailored stimulation protocols improve outcomes whilst reducing adverse effects and costs of IVF. Hum Reprod 2011; 26: 2353-2362. [DOI:10.1093/humrep/der182]
14. La Marca A, Sunkara SK. Individualization of controlled ovarian stimulation in IVF using ovarian reserve markers: from theory to practice. Hum Reprod Update 2014; 20: 124-140. [DOI:10.1093/humupd/dmt037]
15. Hamdine O, Eijkemans MJ, Lentjes EW, Torrance HL, Macklon NS, Fauser BC, et al. Ovarian response prediction in GnRH antagonist treatment for IVF using anti-Müllerian hormone. Hum Reprod 2015; 30: 170-8. [DOI:10.1093/humrep/deu266]
16. Seifer DB, MacLaughlin DT, Christian BP, Feng B, Shelden RM. Early follicular serum müllerian-inhibiting substance levels are associated with ovarian response during assisted reproductive technology cycles. Fertil Steril 2002; 77: 468- 471. [DOI:10.1016/S0015-0282(01)03201-0]
17. Al-Inany H1, Aboulghar M. GnRH antagonist in assisted reproduction: a Cochrane review. Hum Reprod 2002; 17: 874-885. [DOI:10.1093/humrep/17.4.874]
18. Nelson SM. Biomarkers of ovarian response: current and future applications. Fertil Steril 2013; 99: 963-969. [DOI:10.1016/j.fertnstert.2012.11.051]
19. Marci R, Caserta D, Dolo V, Tatone C, Pavan A, Moscarini M. GnRH antagonist in IVF poor-responder patients: results of a randomized trial. Reprod Biomed Online 2005; 11: 189-193. [DOI:10.1016/S1472-6483(10)60957-1]
20. Copperman AB, Benadiva C. Optimal usage of the GnRH antagonists: a review of the literature. Reprod Biol Endocrinol 2013; 11: 20-33. [DOI:10.1186/1477-7827-11-20]
21. Pu D, Wu J, Liu J. Comparisons of GnRH antagonist versus GnRH agonist protocol in poor ovarian responders undergoing IVF. Hum Reprod 2011; 11: 2742-2749. [DOI:10.1093/humrep/der240]
22. Malmusi S, La Marca A, Giulini S, Xella S, Tagliasacchi D, Marsella T, et al. Comparison of a gonadotropin-releasing hormone (GnRH) antagonist and GnRH agonist flare-up regimen in poor responders undergoing ovarian stimulation. Fertil Steril 2005; 84: 402-406. [DOI:10.1016/j.fertnstert.2005.01.139]
23. Sun Y, Zhu YM. Gonadotropin-releasing hormone antagonist protocol in patients with risk of poor response to ovarian stimulation in IVF-ET. Zhejiang Da Xue Xue Bao Yi Xue Ban 2009; 38: 305-310.
24. Ebner T, Sommergruber M, Moser M, Shebl O, Schreier-Lechner E, Tews G. Basal level of anti-Müllerian hormone is associated with oocyte quality in stimulated cycles. Hum Reprod 2006; 21: 2022-2026. [DOI:10.1093/humrep/del127]
25. Taghavi SA, Ashrafi M, Mehdizadeh M, Karimian L, Joghataie MT, Aflatoonian R. Toll-like receptors expression in follicular cells of patients with poor ovarian response. Int J Fertil Steril 2014; 8: 183-192.
26. Yang S1, Chen XN, Qiao J, Liu P, Li R, Chen GA, et al. Comparison of GnRH antagonist fixed protocol and GnRH agonists long protocol in infertile patients with normal ovarian reserve function in their first in vitro fertilization-embryo transfer cycle. Zhonghua Fu Chan Ke Za Zhi 2012; 47: 245-249.
27. Johnston-MacAnanny EB, DiLuigi AJ, Engmann LL, Maier DB, Benadiva CA, Nulsen JC. Selection of first in vitro fertilization cycle stimulation protocol for good prognosis patients: gonadotropin releasing hormone antagonist versus agonist protocols. J Reprod Med 2011; 56: 12-16.
28. Grow D, Kawwass JF, Kulkarni AD, Durant T, Jamieson DJ, Macaluso M. GnRH agonist and GnRH antagonist protocols: comparison of outcomes among good-prognosis patients using national surveillance data. Reprod Biomed Online 2014; 29: 299-304. [DOI:10.1016/j.rbmo.2014.05.007]
29. Meng Y1, Guo Y, Qian Y, Guo X, Gao L, Sha J, et al. Effects of GnRH antagonist on endometrial protein profiles in the window of implantation. Proteomics 2014; 14: 2350-2359. [DOI:10.1002/pmic.201400145]
30. Haouzi D, Assou S, Dechanet C, Anahory T, Dechaud H, De Vos J, et al. Controlled ovarian hyperstimulation for in vitro fertilization alters endometrial receptivity in humans: protocol effects. Biol Reprod 2010; 82: 679-686. [DOI:10.1095/biolreprod.109.081299]
31. Anckaert E, Smitz J, Schiettecatte J, Klein BM, Arce JC. The value of anti-Mullerian hormone measurement in the long GnRH agonist protocol: association with ovarian response and gonadotrophin-dose adjustments. Hum Reprod 2012; 27: 1829-1839. [DOI:10.1093/humrep/des101]
32. Manno M, Cervi M, Zadro D, Fuggetta G, Adamo V, Tomei F. Different ART outcomes at increasing peak estradiol levels with long and antagonist protocols: retrospective insights from ten year experience. J Assist Reprod Genet 2011; 28: 693-698. [DOI:10.1007/s10815-011-9570-4]
33. Lainas TG, Sfontouris IA, Zorzovilis IZ, Petsas GK, Lainas GT, Alexopoulou E. Flexible GnRH antagonist protocol versus GnRH agonist long protocol in patients with polycystic ovary syndrome treated for IVF: a prospective randomised controlled trial (RCT). Hum Reprod 2010; 25: 683-689. [DOI:10.1093/humrep/dep436]

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