International Journal of
Reproductive Biomedicine
Sun, Dec 22, 2024
[Archive]
Volume 15, Issue 4 (6-2017)
IJRM 2017, 15(4): 231-238 |
Back to browse issues page
Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
Aflatoonian A, Hosseinisadat R, Baradaran R, Mojtahedi M F. Pregnancy outcome of “delayed start” GnRH antagonist protocol versus GnRH antagonist protocol in poor responders: A clinical trial study. IJRM 2017; 15 (4) :231-238
URL: http://ijrm.ir/article-1-813-en.html
URL: http://ijrm.ir/article-1-813-en.html
1- Research and Clinical Center for Infertility, Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
2- Department of Obstetrics and Gynecology, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
3- Department of Obstetrics and Gynecology, Endocrinology and Female Infertility Unit, Roointan Arash Women’s Health Research and Educational Hospital, Tehran University of Medical Sciences, Tehran, Iran
2- Department of Obstetrics and Gynecology, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
3- Department of Obstetrics and Gynecology, Endocrinology and Female Infertility Unit, Roointan Arash Women’s Health Research and Educational Hospital, Tehran University of Medical Sciences, Tehran, Iran
Abstract: (3376 Views)
Background: Management of poor-responding patients is still major challenge inassisted reproductive techniques (ART). Delayed-start GnRH antagonist protocol isrecommended to these patients, but little is known in this regards.
Objective: The goal of this study was assessment of delayed-start GnRH antagonistprotocol in poor responders, and in vitro fertilization (IVF) outcomes.
Materials and Methods: This randomized clinical trial included sixty infertilewomen with Bologna criteria for ovarian poor responders who were candidate forIVF. In case group (n=30), delayed-start GnRH antagonist protocol administeredestrogen priming followed by early follicular-phase GnRH antagonist treatment for7 days before ovarian stimulation with gonadotropin. Control group (n=30) treatedwith estrogen priming antagonist protocol. Finally, endometrial thickness, the ratesof oocytes maturation, , embryo formation, and pregnancy were compared betweentwo groups.
Results: Rates of implantation, chemical, clinical, and ongoing pregnancy indelayed-start cycles were higher although was not statistically significant.Endometrial thickness was significantly higher in case group. There were nostatistically significant differences in the rates of oocyte maturation, embryoformation, and IVF outcomes between two groups.
Conclusion: Delayed-start GnRH antagonist protocol can be a new hope method totreatment poor ovarian responders.
Objective: The goal of this study was assessment of delayed-start GnRH antagonistprotocol in poor responders, and in vitro fertilization (IVF) outcomes.
Materials and Methods: This randomized clinical trial included sixty infertilewomen with Bologna criteria for ovarian poor responders who were candidate forIVF. In case group (n=30), delayed-start GnRH antagonist protocol administeredestrogen priming followed by early follicular-phase GnRH antagonist treatment for7 days before ovarian stimulation with gonadotropin. Control group (n=30) treatedwith estrogen priming antagonist protocol. Finally, endometrial thickness, the ratesof oocytes maturation, , embryo formation, and pregnancy were compared betweentwo groups.
Results: Rates of implantation, chemical, clinical, and ongoing pregnancy indelayed-start cycles were higher although was not statistically significant.Endometrial thickness was significantly higher in case group. There were nostatistically significant differences in the rates of oocyte maturation, embryoformation, and IVF outcomes between two groups.
Conclusion: Delayed-start GnRH antagonist protocol can be a new hope method totreatment poor ovarian responders.
Type of Study: Original Article |
References
1. Davar R, Rahsepar M, Rahmani E. A comparative study of luteal estradiol pre-treatment in GnRH antagonist protocols and in micro dose flare protocols for poor-responding patients. Arch Gynecol Obstet 2013; 287: 149-153. [DOI:10.1007/s00404-012-2522-0]
2. Tarlatzis BC, Zepiridis L, Grimbizis G, Bontis J. Clinical management of low ovarian response to stimulation for IVF: a systematic review. Hum Reprod Update 2003; 9: 61-76. [DOI:10.1093/humupd/dmg007]
3. Garcia J, Jones GS, Acosta AA, Wright Jr GL. Corpus luteum function after follicle aspiration for oocyte retrieval. Fertil Steril 1981; 36: 565-572. [DOI:10.1016/S0015-0282(16)45852-8]
4. Kahraman K, Berker B, Atabekoglu CS, Sonmezer M, Cetinkaya E, Aytac R, Satiroglu H. Microdose gonadotropin-releasing hormone agonist flare-up protocol versus multiple dose gonadotropin-releasing hormone antagonist protocol in poor responders undergoing intracytoplasmic sperm injection-embryo transfer cycle. Fertil Steril 2009; 91: 2437-2444. [DOI:10.1016/j.fertnstert.2008.03.057]
5. Keay SD. Poor ovarian response to gonadotrophin stimulation-The role of adjuvant treatments. Hum Fertil 2002; 5 (Suppl.): S46-52. [DOI:10.1080/1464727022000199921]
6. Polyzos NP, Tournaye H. Poor ovarian responders: to meta-analyses or not, that is the question. Hum Reprod 2014: det426. [DOI:10.1093/humrep/det426]
7. Akande VA, Fleming CF, Hunt LP, Keay SD, Jenkins JM. Biological versus chronological ageing of oocytes, distinguishable by raised FSH levels in relation to the success of IVF treatment. Hum Reprod 2002; 17: 2003-2008. [DOI:10.1093/humrep/17.8.2003]
8. Ferraretti A, La Marca A, Fauser BC, Tarlatzis B, Nargund G, Gianaroli L, ESHRE working group on Poor Ovarian Response Definition. ESHRE consensus on the definition of 'poor response'to ovarian stimulation for in vitro fertilization: the Bologna criteria. Hum Reprod 2011; 26: 1616- 1624. [DOI:10.1093/humrep/der092]
9. De Sutter P, Dhont M. Poor response after hormonal stimulation for in vitro fertilization is not related to ovarian aging. Fertil Steril 2003; 79: 1294-1298. [DOI:10.1016/S0015-0282(03)00264-4]
10. Oudendijk JF, Yarde F, Eijkemans MJ, Broekmans FJ, Broer SL. The poor responder in IVF: is the prognosis always poor? A systematic review. Hum Reprod Update 2012; 18: 1-1. [DOI:10.1093/humupd/dmr037]
11. Fauser BC, van HeusdenAM. Manipulation of Human Ovarian Function: Physiological Concepts and Clinical Consequences 1. Endocr Rev 1997; 18: 71-106. [DOI:10.1210/er.18.1.71]
12. Surrey ES, Schoolcraft WB. Evaluating strategies for improving ovarian response of the poor responder undergoing assisted reproductive techniques. Fertil Steril 2000; 73: 667-676. [DOI:10.1016/S0015-0282(99)00630-5]
13. Chun SY, Eisenhauer KM, Minami SA, Billig H, Perlas EM, Hsueh AJ. Hormonal regulation of apoptosis in early antral follicles: follicle-stimulating hormone as a major survival factor. Endocrinology 1996; 137: 1447-1456. [DOI:10.1210/endo.137.4.8625923]
14. Klein NA, Battaglia DE, Fujimoto VY, Davis GS, Bremner WJ, Soules MR. Reproductive aging: accelerated ovarian follicular development associated with a monotropic follicle-stimulating hormone rise in normal older women. J Clin Endocrinol Metab 1996; 81:1038-1045.
15. Roseff SJ, Bangah ML, Kettel LM, Vale W, Rivier J, Burger HG, Yen SS. Dynamic Changes in Circulating Inhibin Levels during the Luteal-Follicular Transition of the Human Menstrual Cycle. J Clin Endocrinol Metab 1989; 69: 1033-1039. [DOI:10.1210/jcem-69-5-1033]
16. Mais V, Cetel NS, Muse KN, Quigley ME, Reid RL, Yen SS. Hormonal dynamics during luteal-follicular transition. J Clin Endocrinol Metab 1987; 64: 1109-1114. [DOI:10.1210/jcem-64-6-1109]
17. Hill MJ, McWilliams GD, Miller KA, Scott RT, Frattarelli JL. A luteal estradiol protocol for anticipated poor-responder patients may improve delivery rates. Fertil Steril 2009; 91: 739-743. [DOI:10.1016/j.fertnstert.2007.12.073]
18. Schachter M, Friedler S, Raziel A, Strassburger D, Bern O, Ron-El R. Clinical Assisted Reproduction: Improvement of IVF Outcome in Poor Responders by Discontinuation of GnRH Analogue During the Gonadotropin Stimulation Phase-A Function of Improved Embryo Quality. J Assist Reprod Genet 2001; 18: 199-206. [DOI:10.1023/A:1009476411762]
19. Feldberg D, Farhi J, Ashkenazi J, Dicker D, Shalev J, Ben-Rafael Z. Minidose gonadotropin-releasing hormone agonist is the treatment of choice in poor responders with high follicle-stimulating hormone levels. Fertil Steril 1994; 62: 343-346. [DOI:10.1016/S0015-0282(16)56889-7]
20. Olivennes F, Righini C, Fanchin R, Torrisi C, Hazout A, Glissant M, Fernandez H, Frydman R. A protocol using a low dose of gonadotrophin-releasing hormone agonist might be the best protocol for patients with high follicle stimulating hormone concentrations on day 3. Hum Reprod 1996; 11: 1169-1172. [DOI:10.1093/oxfordjournals.humrep.a019348]
21. Fanchin R, Cunha-Filho JS, Schonäuer LM, Righini C, de Ziegler D, Frydman R. Luteal estradiol administration strengthens the relationship between day 3 follicle-stimulating hormone and inhibin B levels and ovarian follicular status. Fertil Steril 2003; 79: 585-589. [DOI:10.1016/S0015-0282(02)04757-X]
22. Fanchin R, Cunha-Filho JS, Schonauer LM, Kadoch IJ, Cohen-Bacri P, Frydman R. Coordination of early antral follicles by luteal estradiol administration provides a basis for alternative controlled ovarian hyperstimulation regimens. Fertil Steril 2003; 79: 316 -321. [DOI:10.1016/S0015-0282(02)04574-0]
23. Fanchin R, Salomon L, Castelo‐Branco A, Olivennes F, Frydman N, Frydman R. Luteal estradiol pre‐treatment coordinates follicular growth during controlled ovarian hyperstimulation with GnRH antagonists. Hum Reprod 2003; 18: 2698-2703. [DOI:10.1093/humrep/deg516]
24. Fanchin R, Branco AC, Kadoch IJ, Hosny G, Bagirova M, Frydman R. Premenstrual administration of gonadotropin-releasing hormone antagonist coordinates early antralfollicle sizes and sets up the basis for an innovative concept of controlled ovarian hyperstimulation. Fertil Steril 2004; 81: 1554-1559. [DOI:10.1016/j.fertnstert.2003.11.037]
25. Cakmak H, Tran ND, Zamah AM, Cedars MI, Rosen MP. A novel "delayed start" protocol with gonadotropin-releasing hormone antagonist improves outcomes in poor responders. Fertil Steril 2014; 101: 1308-1314. [DOI:10.1016/j.fertnstert.2014.01.050]
26. Cruz M, Gadea B, Garrido N, Pedersen KS, Martínez M, Pérez-Cano I, Mu-oz M, Meseguer M. Embryo quality, blastocyst and ongoing pregnancy rates in oocyte donation patients whose embryos were monitored by time-lapse imaging. J Assist Reprod Genet 2011; 28: 569-573. [DOI:10.1007/s10815-011-9549-1]
27. Weitzman VN, Engmann L, DiLuigi A, Maier D, Nulsen J, Benadiva C. Comparison of luteal estradiol patch and gonadotropin-releasing hormone antagonist suppression protocol before gonadotropin stimulation versus microdose gonadotropin-releasing hormone agonist protocol for patients with a history of poor in vitro fertilization outcomes. Fertil Steril 2009; 92: 226-230. [DOI:10.1016/j.fertnstert.2008.04.024]
28. Buster J, Bustillo M, Thorneycroft I, Simon J, Boyers S, Marshall J, Louw J, Seed R, Seed R. Non-surgical transfer of in vivo fertilised donated ova to five infertile women: report of two pregnancies. Lancet 1983; 322: 223-224. [DOI:10.1016/S0140-6736(83)90208-8]
29. Keltz M, Sauerbrun-Cutler MT, Breborowicz A. Managing poor responders in IVF. Exp Rev Obstet Gynecol 2014; 8: 121-134. [DOI:10.1586/eog.13.1]
30. Pu D, Wu J, Liu J. Comparisons of GnRH antagonist versus GnRH agonist protocol in poor ovarian responders undergoing IVF. Hum Reprod 2011: 26: 2742-2749. [DOI:10.1093/humrep/der240]
31. Akman MA, Erden HF, Tosun SB, Bayazit N, Aksoy E, Bahceci M. Comparison of agonistic flare-up-protocol and antagonistic multiple dose protocol in ovarian stimulation of poor responders: results of a prospective randomized trial. Hum Reprod 2001; 16: 868-870. [DOI:10.1093/humrep/16.5.868]
32. Kahraman K, Berker B, Atabekoglu CS, Sonmezer M, Cetinkaya E, Aytac R, Satiroglu H. Microdose gonadotropin-releasing hormone agonist flare-up protocol versus multiple dose gonadotropin-releasing hormone antagonist protocol in poor responders undergoing intracytoplasmic sperm injection-embryo transfer cycle. Fertil Steril 2009; 91: 2437-2444. [DOI:10.1016/j.fertnstert.2008.03.057]
33. Dragisic KG, Davis OK, Fasouliotis SJ, Rosenwaks Z. Use of a luteal estradiol patch and a gonadotropin-releasing hormone antagonist suppression protocol before gonadotropin stimulation for in vitro fertilization in poor responders. Fertil Steril 2005; 84: 1023-1026. [DOI:10.1016/j.fertnstert.2005.04.031]
34. Ata B, Zeng X, Son WY, Holzer H, Tan SL. Follicular synchronization using transdermal estradiol patch and GnRH antagonists in the luteal phase; does it increase oocyte yield in poor responders to gonadotropin stimulation for in vitro fertilization (IVF)? A comparative study with microdose flare-up protocol. Gynecol Endocrinol 2011; 27: 876-879. [DOI:10.3109/09513590.2011.569596]
35. Shastri SM, Barbieri E, Kligman I, Schoyer KD, Davis OK, Rosenwaks Z. Stimulation of the young poor responder: comparison of the luteal estradiol/gonadotropin-releasing hormone antagonist priming protocol versus oral contraceptive microdose leuprolide. Fertil Steril 2011; 95: 592-595. [DOI:10.1016/j.fertnstert.2010.10.003]
36. Mashayekhi M, Karimzadeh MA. Comparison of mild and microdose GnRH agonist flare protocols on IVF outcome in poor responders. Arch Gynecol Obstet 2011; 283: 1159-1164 [DOI:10.1007/s00404-010-1828-z]
| Rights and permissions | |
 |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
