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Schächter, M; Friedler, Shevach; Raziel, Arié; Strassburger, D.; Bern, O.; Ron-El, Raphaël

doi:10.1023/a:1009476411762

Cited by 33 publications

(6 citation statements)

References 41 publications

(33 reference statements)

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“…The rationale to lower or to stop (after pituitary suppression) the dose of GnRH agonists initiated during the luteal phase is to obtain a reduction of the inhibitory direct effect of the GnRH agonist on the gonads [ 55 , 56 ]. Initially, several trials (prospective nonrandomized studies with historical control) on the use of “GnRH agonist stopped protocol” in poor responders reported a reduction in the amount of gonadotropin administered and improved laboratory results and clinical outcome [ 47 , 63 , 64 ]. Unfortunately, two prospective randomized controlled trials did not confirm improvements in reproductive outcome when this stimulation regimen is used compared to standard stimulation protocols [ 65 , 66 ].…”

Section: Is There An Ideal Protocol?mentioning

confidence: 99%

Management of Poor Responders in IVF: Is There Anything New?

Ubaldi

Vaiarelli²,

D’Anna³

et al. 2014

BioMed Research International

128

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Despite the fact that in the last two decades an enormous number of papers on the topic of poor ovarian response have been published in the literature, so far it has been impossible to identify any efficient treatment to improve the ovarian response and the clinical outcome of this group of patients. The incidence of poor ovarian responders among infertile women has been estimated at 9–24% but according to recent reviews, it seems to have slightly increased. The limitation in quantifying the incidence of these patients among the infertile population is due to the difficulty of a clear definition in literature. A recent paper by the Bologna ESHRE working group on poor ovarian response has been the first real attempt to find a common definition. Current literature proposes new risk factors which could be the cause of a reduction in ovarian reserve, which also includes genetic factors. This represents the first necessary step towards finding applicable solutions for these patients. To date, there is a substantial lack of literature that identifies an ideal protocol for these patients. The use of the “Bologna criteria” and the introduction of long acting gonadotropin in clinical practice have given rise to new promising stimulation protocols for this group of patients.

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Section: Is There An Ideal Protocol?mentioning

confidence: 99%

Management of Poor Responders in IVF: Is There Anything New?

Ubaldi

Vaiarelli²,

D’Anna³

et al. 2014

BioMed Research International

128

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“…One of the reasons behind using GnRH agonist or birth control pills in the late luteal phase is to suppress FSH rise and subsequent premature dominant follicle selection. However, for poor responders, down regulation protocol with GnRH agonist or birth control pills before antagonist protocol may cause over-suppression on ovarian function leading to low oocyte yield (13). As a result, incorporating estradiol pretreatment to the GnRH antagonist protocol gained attention to lower endogenous luteal FSH secretion without suppressing the ovarian response.…”

Section: Introductionmentioning

confidence: 99%

A novel “delayed start” protocol with gonadotropin-releasing hormone antagonist improves outcomes in poor responders

Çakmak

Tran

Zamah

et al. 2014

Fertility and Sterility

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Objective To investigate whether delaying the start of ovarian stimulation with GnRH antagonist improves ovarian response in poor responders. Design Retrospective study Setting Academic medical center Patients Thirty patients, who responded poorly and did not get pregnant with conventional estrogen priming antagonist IVF protocol. Intervention(s) Delayed start antagonist protocol (estrogen priming followed by early follicular phase GnRH antagonist treatment for 7 days prior to ovarian stimulation) Main Outcome Measure(s) Number of dominant follicles and mature oocytes retrieved, mature oocyte yield and fertilization rate. Results The number of patients who met the criteria to proceed to oocyte retrieval was significantly higher in delayed start protocol [21/30 (70%)] compared to patient’s previous conventional estrogen priming antagonist cycle [11/30 (36.7%)]. The number of dominant follicles was significantly higher in delayed start (4.2 ± 2.7) compared with conventional protocol (2.4 ± 1.3). In patients, who had oocyte retrieval after both protocols (n=9), the delayed start resulted in shorter ovarian stimulation (9.4 ± 1.4 vs. 11.1 ± 2.0 days), higher number of mature oocytes retrieved (4.9 ± 2.0 vs. 2.2 ± 1.1) and trend toward increased fertilization rates with ICSI (86 ± 17% vs. 69 ± 21%) compared to conventional protocol. After delayed start, the average number of embryos transferred was 2.8 ± 1.4 with implantation rate of 9.8% and clinical pregnancy rate of 23.8%. Conclusions The delayed start protocol improves ovarian response in poor responders, by promoting and synchronizing follicle development without impairing oocyte developmental competence.

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“…Schachter et al. also found significantly more cleaving embryos with improved morphology after discontinued GnRH-a protocol in comparison with long agonist protocol ( 14 ).…”

Section: Discussionmentioning

confidence: 94%

“…and Hazout et al. hypothesized that POR benefits from a double stimulation (flare up effect then gonadotropins) associated with a less strenuous blockage (discontinuation of GnRH-a) to favor follicular recruitment in order to obtain a better ovarian response and produce more oocytes and embryos, including more usable embryos, increasing chances of ongoing pregnancies (OP) in these low prognosis patients ( 14 , 15 ). Based on this data, we proposed to our poor responders patients the “Short agonist stop” (SAS) protocol that uses GnRH-a at first for the flare up effect at the beginning of the cycle for 7 days in total then stopped, enabling pituitary desensitization in order to prevent a premature LH surge, associated with a controlled ovarian stimulation with gonadotropins at maximum dosage (300IU/d) ( 15 – 18 ) ( Figure 1 ).…”

Section: Introductionmentioning

confidence: 99%

“Short agonist stop” protocol, an ovarian stimulation for poor responders in in vitro fertilization (IVF): A pilot study

et al. 2022

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IntroductionPoor responder patients remain a challenge in assisted reproductive technologies. The “short agonist stop” (SAS) stimulation protocol uses a double stimulation (flare up effect with the gonadotropin-releasing hormone (GnRH) agonist (GnRH-a) then gonadotropins) associated with a less strenuous blockage (discontinuation of GnRH-a) to favor follicular recruitment in order to obtain a better ovarian response. This study aims to compare the number of oocytes obtained after a SAS stimulation protocol with those obtained after the previous stimulation protocol, in the same women, with poor ovarian response (POR) diagnosed according to the POSEIDON criteria.DesignThis therapeutic observational retrospective cohort from 2018 to 2022, with a case-control evaluation compared with the same patients’ previous performance, included women with POR undergoing IVF with SAS stimulation protocol. The primary outcome was the number of total oocytes recovered and secondary outcomes were the numbers of mature oocytes, total embryos observed at day 2 and usable cleaved embryos and blastocysts (day 5/6).Results63 patients with SAS and previous cycles were included. In the SAS group, the mean number of oocytes was significantly higher: 7.3 vs 5.7, p=0.018 in comparison with the previous attempt. So was the number of mature oocytes (5.8 vs 4.1, p=0.032) and the total mean number of embryos obtained at day 2 (4.1 versus 2.7, p=0.016). The SAS stimulation generated 84 usable embryos: 57 cleaved embryos and 27 blastocysts. The mean number of usable embryos was similar in both groups (1.64 vs 1.31, respectively, p=0.178). In total, out of 63 patients, after the SAS protocol, and subsequent embryo transfers (fresh and frozen, n=54), 9 patients had ongoing pregnancies and no miscarriage occurred. The cumulative ongoing pregnancy rate (cOPR) after the SAS protocol was 14.3% (9/63) per oocyte pick-up and 16.7% (9/54) per transfer.ConclusionSAS stimulation is a short and original protocol strengthening the therapeutic arsenal of poor responders, that may offer promising results for those patients with low prognosis and previous failed IVF. Results must be confirmed with a randomized controlled trial.

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Untitled

Cited by 33 publications

References 41 publications

Management of Poor Responders in IVF: Is There Anything New?

Management of Poor Responders in IVF: Is There Anything New?

A novel “delayed start” protocol with gonadotropin-releasing hormone antagonist improves outcomes in poor responders

“Short agonist stop” protocol, an ovarian stimulation for poor responders in in vitro fertilization (IVF): A pilot study

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