A modified ultra-long pituitary downregulation protocol improved endometrial receptivity and clinical outcome for infertile patients with polycystic ovarian syndrome

Abstract

There are currently various protocols for in vitro fertilization (IVF). For patients with polycystic ovarian syndrome (PCOS), an optimized protocol for the downregulation of pituitary follicle stimulating hormone and luteinizing hormone via gonadotropin-releasing hormone agonist (GnRHa) remains a challenge. In the present study, the primary endpoint of an ultra-long and a conventional long GnRHa protocol for intracytoplasmic sperm injection/IVF treatments of patients with PCOS was retrospectively compared. In the modified ultra-long protocol group, endometrial thickness, morphology, and blood flow were significantly improved, as compared with in the conventional long protocol group. Furthermore, the serum progestogen (P) concentrations and P/estrogen (E2) [(Px1,000/E2)] ratio on the day of human chorionic gonadotrophin administration were significantly decreased in the modified ultra-long downregulation group, whereas the pregnancy and implantation rates were significantly higher. There were no significant differences in the average number of obtained oocytes, good quality embryo rates, cancel rates, fertilization rates, abortion rates, serious ovarian hyperstimulation syndrome incidences, ectopic pregnancy rates or gonadotropin (Gn) dosages between the two groups. These results suggest that the modified ultra-long protocol plus human menopausal Gn medication may be superior to the conventional long protocol, and may lead to improved implantation and pregnancy outcomes for infertile patients with PCOS.

Microdissection testicular sperm extraction in five Japanese patients with non‐mosaic Klinefelter's syndrome

“…Depending on the menstrual cycle, there are variations in the cancellation rates and the number of days of administration of gonadotropin. By contrast, although it is a study about the COS protocol in polycystic ovarian syndrome, there is a report that the cancellation rate was 9.33% and the number of gonadotropin administration days up to egg collection was 11.52 ± 2.15 in the modified ultra‐long method …”

“…In all cases, the oocyte‐retrieval date was adjusted from the wife of the patient to coincide with the day of the micro‐TESE. Ovulation induction was performed by using the authors' own method, based on the modified ultra‐long protocol . Each patient began treatment with 900 μg/d of gonadotropin‐releasing hormone (GnRH) agonist (suprecur) nasal drops from the high‐temperature phase of the menstrual cycle and ~30–40 days before the scheduled micro‐TESE.…”

“…Ovulation induction was performed by using the authors' own method, based on the modified ultra-long protocol. 14 Cryo-micro-TESE ICSI was performed; however, a viable blastocyst did not develop and she has not become pregnant yet.…”

The clinical and neonatal outcomes after stimulation of immotile spermatozoa using SperMagic medium

“…All patients underwent controlled ovarian stimulation induced by recombinant follicle‐stimulating hormone (r‐FSH; Gonal‐F; Merck Serono, Switzerland) following pituitary downregulation by the administration of gonadotropin‐releasing hormone analogues (GnRH‐a), as reported previously (Gong et al., ). A G‐Series culture medium (Vitrolife, Gothenburg, Sweden) was used for in vitro embryo culture.…”

Polar body transfer restores the developmental potential of oocytes to blastocyst stage in a case of repeated embryo fragmentation

“…In the patient's first cycle at our center, the patient was stimulated with an ultra-long downregulation protocol [25]. The oocytes were inseminated with her husband's sperm, which was characterized by normal count and progressive motility.…”