A novel approach using a minimal number of injections during the IVF/ICSI cycle: Luteal half-dose depot GnRH agonist following corifollitropin alfa versus the corifollitropin alfa with a GnRH-antagonist cycle

Haydardedeoğlu, Bülent; Kılıçdağ, Esra Bulgan

doi:10.5152/jtgga.2016.16015

“…rFSH from the 5th day from CFA, the day when circulating level star to decrease, was given to maintain the FSH effect and rLH was added to complete maturation of oocytes, although its role is still controversial, and to improve endometrial receptivity [21,22]. The studies performed with CFA in long agonists protocols [12,17], showed that CFA can be safely used in normal and poor responders. The use of antagonist protocols or long agonist protocols in poor responders show comparable results, better than those observed with short agonist protocols [3].…”

Section: Discussionmentioning

confidence: 99%

“…Recently, CFA has also been used with GnRH agonists, either in long protocol or with flare up protocol [ 10 – 12 ]. The rationale of the use of CFA in poor responders is related to its more precocious achievement of the threshold and to its higher level of FSH, that might allow the recruitment of a higher percentage of the few available follicles in these patients.…”

Section: Introductionmentioning

confidence: 99%

Corifollitropin alfa for poor responders patients, a prospective randomized study

Fusi

¹

,

Zanga

²

,

Arnoldi

³

et al. 2020

Reprod Biol Endocrinol

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Background: Poor ovarian response remains one of the biggest challenges for reproductive endocrinologists. The introduction of corifollitropin alpha (CFA) offered an alternative option to other gonadotropins for its longer halflife, its more rapid achievement of the threshold and higher FSH levels. We compared two different protocols with CFA, a long agonist and a short antagonist, and a no-CFA protocol. Methods: Patients enrolled fulfilled at least two of the followings: AFC < 5, AMH < 1,1 ng/ml, less than three oocytes in a previous cycle, age > 40 years. Ovarian stimulation with an antagonist protocol was performed either with 300 UI rFSH and 150 UI rLH or 300UI HMG. In the long agonist group, after pituitary suppression with triptorelin, CFA was given the 1-2th day of cycle and 300 UI rFSH and 150 UI rLH the 5th day. In the short antagonist group CFA was given the 1-2th day of cycle and 300 UI rFSH and 150 UI rLH the 5th day. The primary objective was the effect on the number of oocytes and MII oocytes. Secondary objective were pregnancy rates, ongoing pregnancies and ongoing pregnancies per intention to treat. Results: The use of CFA resulted in a shorter lenght of stimulation and a lower number of suspended treatments. Both the CFA protocols were significantly different from the no-CFA group in the number of retrieved oocytes (p < 0,05), with a non-significant difference in favour of the long agonist protocol. Both CFA groups yielded higher pregnancy rates, especially the long protocol, due to the higher number of oocytes retrieved (p < 0,05), as implantation rates did not differ. The cumulative pregnancy rate was also different, due to the higher number of cryopreserved blastocysts (p < 0,02). Conclusions: The long agonist protocol with the addition of rFSH and rLH showed the best results in all the parameters. A short antagonist protocol with CFA was less effective, but not significantly, although provided better results compared to the no-CFA group. We suggest that a long agonist protocol with CFA and recombinant gonadotropins might be a valuable option for poor responders. Trial registration: The study was approved by the local Ethics Committee (EudraCT2015-002817-31).

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“…Manuscript to be reviewed 57 procedures. These drugs provided many benefits, such as the recovery of a larger number of 58 oocytes, prevention of premature luteinizing hormone (LH) surge, luteinization, and a lower 59 cycle cancellation rate [Haydardedeoğlu & Kılıçdağ, 2016;Siristatidis et al, 2015; Xiao, Su 60 & Zeng, 2014]. Utilizing GnRH-a has been considered the gold standard for COH.…”

Section: Introductionmentioning

confidence: 99%

“…54 INTRODUCTION 55 Over the last three decades, gonadotropin-releasing hormone agonists (GnRH-a) were the most 56 commonly used drugs for controlled ovarian hyperstimulation (COH) in assisted reproductive PeerJ reviewing PDF |Manuscript to be reviewed 57 procedures. These drugs provided many benefits, such as the recovery of a larger number of 58 oocytes, prevention of premature luteinizing hormone (LH) surge, luteinization, and a lower 59 cycle cancellation rate [Haydardedeoğlu & Kılıçdağ, 2016;Siristatidis et al, 2015; Xiao, Su 60 & Zeng, 2014]. Utilizing GnRH-a has been considered the gold standard for COH.…”

mentioning

confidence: 99%

Peer Review #4 of "Prolonged pituitary down-regulation with full-dose of gonadotropin-releasing hormone agonist in different menstrual cycles: a retrospective cohort study (v0.2)"

2019

0

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Background:The efficiency of prolonged down-regulation caused by a full-dose of gonadotropin-releasing hormone agonist (GnRH-a) injected during different menstrual phases has not yet been researched. Our goal was to evaluate the effects of GnRH-a, which was used in different phases of the menstrual cycle in patients undergoing in vitro fertilization and embryo transfer (IVF-ET). Methods: This was a retrospective cohort study.Three hundred and twenty patients received a prolonged pituitary down-regulated fulldose (3.75mg) of triptorelin in the early follicular phase, and 160 patients received the same full-dose of triptorelin during the mid-luteal phase. Clinical and laboratory outcomes were compared between the two groups. Results: The basic characteristics of the two groups were comparable. The mean number of retrieved oocytes, fertilized oocytes, cleavage oocytes and good quality embryos were comparable between the two groups.Although there was a higher antral follicle count (AFC), cyst formation rate, fertilization rate and cleavage rate in the follicular phase group, no statistically significant effects were seen on implantation rate (41.15% vs. 45.91%), clinical pregnancy rate (60.38% vs. 61.36%), ongoing pregnancy rate (57.74% vs. 57.58%), live birth rate (56.23% vs. 57.58%) or early abortion rate (2.64% vs. 3.79%) per fresh transfer cycle. Moreover, severe ovarian hyper-stimulation syndrome (OHSS) rates at the early stage (1.89% vs. 2.27%) were low in both groups. Conclusions: Prolonged pituitary down-regulation achieved by utilizing a full-dose of GnRH-a administrated in either phase of the menstrual cycle can have a positive effect on ongoing pregnancy rate and live-birth rate per fresh embryo transfer cycle. Ovarian cyst formation rate was higher in the follicular phase group, but this did not have any adverse impact on clinical results. PeerJ reviewing PDF | 28 29 30 ABSTRACT 31 Background: The efficiency of prolonged down-regulation caused by a full-dose of 32 gonadotropin-releasing hormone agonist (GnRH-a) injected during different menstrual phases 33 has not yet been researched. Our goal was to evaluate the effects of GnRH-a, which was used in 34 different phases of the menstrual cycle in patients undergoing in vitro fertilization and embryo 35 transfer (IVF-ET). 36 Methods: This was a retrospective cohort study. Three hundred and twenty patients received a 37 prolonged pituitary down-regulated full-dose (3.75mg) of triptorelin in the early follicular phase, PeerJ reviewing PDF | Manuscript to be reviewed 38 and 160 patients received the same full-dose of triptorelin during the mid-luteal phase. Clinical 39 and laboratory outcomes were compared between the two groups. 40 Results: The basic characteristics of the two groups were comparable. The mean number of 41 retrieved oocytes, fertilized oocytes, cleavage oocytes and good quality embryos were 42 comparable between the two groups. Although there was a higher antral follicle count (AFC), 43 cyst formation rate, fertilization rate and cleavage rate ...

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“…54 INTRODUCTION 55 Over the last three decades, gonadotropin-releasing hormone agonists (GnRH-a) were the most 56 commonly used drugs for controlled ovarian hyperstimulation (COH) in assisted reproductive PeerJ reviewing PDF |Manuscript to be reviewed 57 procedures. These drugs provided many benefits, such as the recovery of a larger number of 58 oocytes, prevention of premature luteinizing hormone (LH) surge, luteinization, and a lower 59 cycle cancellation rate [Haydardedeoğlu & Kılıçdağ, 2016;Siristatidis et al, 2015; Xiao, Su 60 & Zeng, 2014]. Utilizing GnRH-a has been considered the gold standard for COH.…”

mentioning

confidence: 99%

Peer Review #4 of "Prolonged pituitary down-regulation with full-dose of gonadotropin-releasing hormone agonist in different menstrual cycles: a retrospective cohort study (v0.3)"

2019

0

View full text Add to dashboard Cite

Background:The efficiency of prolonged down-regulation caused by a full-dose of gonadotropin-releasing hormone agonist (GnRH-a) injected during different menstrual phases has not yet been researched. Our goal was to evaluate the effects of GnRH-a, which was used in different phases of the menstrual cycle in patients undergoing in vitro fertilization and embryo transfer (IVF-ET). Methods: This was a retrospective cohort study.Three hundred and twenty patients received a prolonged pituitary down-regulated fulldose (3.75mg) of triptorelin in the early follicular phase, and 160 patients received the same full-dose of triptorelin during the mid-luteal phase. Clinical and laboratory outcomes were compared between the two groups. Results: The basic characteristics of the two groups were comparable. The mean number of retrieved oocytes, fertilized oocytes, cleavage oocytes and good quality embryos were comparable between the two groups.Although there was a higher antral follicle count (AFC), cyst formation rate, fertilization rate and cleavage rate in the follicular phase group, no statistically significant effects were seen on implantation rate (41.15% vs. 45.91%), clinical pregnancy rate (60.38% vs. 61.36%), ongoing pregnancy rate (57.74% vs. 57.58%), live birth rate (56.23% vs. 57.58%) or early abortion rate (2.64% vs. 3.79%) per fresh transfer cycle. Moreover, severe ovarian hyper-stimulation syndrome (OHSS) rates at the early stage (1.89% vs. 2.27%) were low in both groups. Conclusions: Prolonged pituitary down-regulation achieved by utilizing a full-dose of GnRH-a administrated in either phase of the menstrual cycle can have a positive effect on ongoing pregnancy rate and live-birth rate per fresh embryo transfer cycle. Ovarian cyst formation rate was higher in the follicular phase group, but this did not have any adverse impact on clinical results. PeerJ reviewing PDF | 28 29 30 ABSTRACT 31 Background: The efficiency of prolonged down-regulation caused by a full-dose of 32 gonadotropin-releasing hormone agonist (GnRH-a) injected during different menstrual phases 33 has not yet been researched. Our goal was to evaluate the effects of GnRH-a, which was used in 34 different phases of the menstrual cycle in patients undergoing in vitro fertilization and embryo 35 transfer (IVF-ET). 36 Methods: This was a retrospective cohort study. Three hundred and twenty patients received a 37 prolonged pituitary down-regulated full-dose (3.75mg) of triptorelin in the early follicular phase, PeerJ reviewing PDF | Manuscript to be reviewed 38 and 160 patients received the same full-dose of triptorelin during the mid-luteal phase. Clinical 39 and laboratory outcomes were compared between the two groups. 40 Results: The basic characteristics of the two groups were comparable. The mean number of 41 retrieved oocytes, fertilized oocytes, cleavage oocytes and good quality embryos were 42 comparable between the two groups. Although there was a higher antral follicle count (AFC), 43 cyst formation rate, fertilization rate and cleavage rate ...

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A novel approach using a minimal number of injections during the IVF/ICSI cycle: Luteal half-dose depot GnRH agonist following corifollitropin alfa versus the corifollitropin alfa with a GnRH-antagonist cycle

Cited by 6 publications

References 16 publications

Corifollitropin alfa for poor responders patients, a prospective randomized study

Corifollitropin alfa for poor responders patients, a prospective randomized study

Peer Review #4 of "Prolonged pituitary down-regulation with full-dose of gonadotropin-releasing hormone agonist in different menstrual cycles: a retrospective cohort study (v0.2)"

Peer Review #4 of "Prolonged pituitary down-regulation with full-dose of gonadotropin-releasing hormone agonist in different menstrual cycles: a retrospective cohort study (v0.3)"

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