A prospective randomised study comparing a GnRH-antagonist versus a GnRH-agonist short protocol for ovarian stimulation in patients referred for IVF

Abstract

Objective: To compare two short protocols for ovarian stimulation in IVF cycles using an antagonist and an agonist short protocol. The outcomes studied were dosis rec FSH needed, days of stimulation, number of oocytes retrieved and pregnancy outcome. Methods: A prospective randomised study design. Inclusion criteria: first or second IVF attempt in women younger than 40 years. In the agonist protocol (Suprefact ® ) nasal spray was used. In the antagonist protocol (Orgalutran) ® was started as soon as at least 1 follicle of 12 mm was visualized on ultrasound. Results: 160 cycles were included in the study: 80 in the antagonist group and 80 in the agonist group. A higher dosis of recombinant FSH (rec FSH) was used for stimulation in the antagonist group (1897 IU versus 1655 IU). Pregnancy rate per ET in the antagonist group was 37% with an ongoing pregnancy rate of 21%/ET and an implantation rate of 22%; versus respectively 39%, 20% and 22% in the agonist treated group. Live birth rate per started cylce was 19% in the antagonist group versus 20% in the agonist group. Conclusion: This study shows that implantation rates, ongoing pregnancy rates and live birth rates are equal in both groups. An identical number of oocytes was retrieved, with no difference in duration of the stimulation although a higher dosis of rec FSH was needed in the antagonist group.

Comparison of the Long-Acting GnRH Agonist Follicular Protocol with the GnRH Antagonist Protocol in Women Undergoing In Vitro Fertilization: A Systematic Review and Meta-analysis

“…For example, a systematic review reported no difference in clinical pregnancy rate and live birth rates with the GnRH antagonist protocol compared with the longacting GnRH agonist protocol; however, the incidence of OHSS was lower in long-acting GnRH agonist protocol [10]. Another study reported equivalent live birth rate with both protocols [11]. The best protocol for IVF is widely debated in the literature and the optimal protocol remains inconclusive because of several confounders including variation in study population, variation in treatment arms apart from agonist and antagonists, and variation in stimulation strategies [1].…”

What should be the protocol selection after failure of in-vitro fertilization at normoresponder patients: Agonist or antagonist?

“…Felberbaum et al have compared GnRH antagonist treatments with luteal long and agonist GnRH protocols in the group under 35 years of age, in the first treatment cycle, having only tubal infertility and classical IVF-applied patients which they classified as the ideal patient group and reported similar embryo transfer rates and clinical pregnancy rates in antagonist-applied patients similar to other agonist protocols ( 18 ) . Gordts et al have compared the short agonist protocol with the antagonist protocol and reported similar implantation, ongoing pregnancy and live birth rates, and also similar cycle periods and obtained oocyte rates ( 19 ) .…”

Açıklanamayan infertilide endometriyal kalınlık ve canlı doğum

“…There are some limitations to our study. Analog and antagonist cycles were evaluated together because there were many publications showing that the success rates in long-agonist or antagonist cycles were similar [12,17]. Chan et al showed that there was no relationship between endometrial thickness and biochemical pregnancy rates, miscarriage rates, and implantation rates [12].…”