A prospective, randomized comparison of two starting doses of recombinant FSH in combination with cetrorelix in women undergoing ovarian stimulation for IVF/ICSI

Wikland, Matts; Bergh, C.; Borg, Kurt E.; Hillensjø, Torbjörn; Howles, C.M.; Knutsson, Anders; Nilsson, Leif; Wood, M.

doi:10.1093/humrep/16.8.1676

Cited by 75 publications

(25 citation statements)

References 12 publications

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“…There was prominent difference among aspirated oocytes between groups in favor of the agonist treatment and similar data were reported for the agonist group in long protocol by Ludwig et al (18). It was suggested that the short induction period of the antagonist group causes these low numbers of oocytes and Wikland et al (19) reported that increasing doses of gonadotropins in antagonist cycles may provide significantly higher numbers of oocytes. However, in our study, although both groups had similar stimulation periods and gonadotropin doses, the antagonist group had significantly lower numbers of oocyte.…”

Section: Discussionsupporting

confidence: 65%

The effects of GnRH analogs on serum and follicular fluid leptin levels and pregnancy outcomes in short protocols of assisted reproductive technology

Ergenoğlu

Yeniel

Akdoğan

et al. 2012

J Turkish German Gynecol Assoc

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Objective:To determine serum and follicular leptin levels in patients using gonadotropin releasing hormone agonist and antagonist in Assisted Reproductive Technology short protocol cycles and to evaluate pregnancy outcomes. Material and Methods:Patients randomly selected to join assisted reproductive technology cycles during February 2004-July 2004 were enrolled in this study. Group 1 consisted of 21 patients receiving r FSH+ GnRH agonists, whereas Group 2 consisted of 34 patients who received r FSH +GnRH antagonists. During the ovulation induction period 5 serum samples were collected (induction day 1, day 3 or antagonist starting day, human chorionic hormone day, oocyte pickup day, and twelfth day of embryo transfer). Follicular fluid samples were collected to be evaluated for leptin, estradiol, prolactin and luteinizing hormone.Results: There was no difference in age, basal FSH, basal LH, and basal E2 between groups. Serum leptin levels were similar in both groups. Also, when each group's serum leptin levels were evaluated according to the presence of pregnancy, there was no significant difference in both groups. When follicle leptin levels were evaluated according to the existence of pregnancy, in both groups the follicle leptin levels were lower in pregnant participants but this difference was not statistically significant. When obesity is defined as body mass index over 26.5, there is a correlation between obesity and leptin levels in Group 2. Conclusion:Our results have shown that both agonists and antagonists have similar efficacy and effect in poor responder women. Leptin levels in either groups, whether pregnant or non-pregnant were not statistically different. This result shows the need for more studies on leptin in infertility. (J Turkish-German Gynecol Assoc 2012; 13: 91-7)Key words: GnRH agonist, GnRH antagonist, ART, leptin, prolactin Received: 10 January, 2012 Accepted: 19 January, 2012 Amaç: Yardımcı Üreme Teknikleri (YÜT) ile kısa protokol uygulanan sikluslarda gonadotropin salgılatıcı hormon (GnRH) agonist ve antagonist uygulanan olgularda serum ve foliküler leptin seviyelerinin belirlenmesi ve gebelik sonuçlarının değerlendirilmesidir. Bulgular: Gruplar arasında yaş, bazal FSH, bazal LH ve bazal E2 açı-sından fark izlenmedi. Serum leptin düzeyleri her iki grupta benzer idi. Ayrıca her grupta gebelik varlığına göre serum leptin seviyeleri değer-lendirildiğinde gruplar arasında fark izlenmedi. Folikül leptin seviyeleri gebelik mevcudiyetine göre değerlendirildiğinde her iki grupta da folikül leptin seviyeleri gebe olgularda daha düşük olmasına rağmen bu fark istatistiksel olarak anlamlı değildi. Obesite vücut kitle indeks değerinin 26.5 üzerinde olması olarak tanımlandığında Grup 2'de leptin seviyeleri ile obesite arasında korelasyon mevcut idi. Gereç ve Yöntemler:Sonuç: Sonuçlarımız düşük cevaplı olgularda hem agonistlerin hem de antagonistlerin benzer etkinlik ve etkiye sahip olduğunu göstermiş-tir. Her iki grupta da leptin seviyeleri gebe olanlarda veya olmayanlarda istatistiksel olarak...

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Section: Discussionsupporting

confidence: 65%

The effects of GnRH analogs on serum and follicular fluid leptin levels and pregnancy outcomes in short protocols of assisted reproductive technology

Ergenoğlu

Yeniel

Akdoğan

et al. 2012

J Turkish German Gynecol Assoc

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“…Two studies were identified that used GnRH-antagonists for pituitary suppression. One compared a starting dose of 150 IU with 200 IU [17], whereas the other compared 150 IU with 225 IU [18]. A summary of the relevant data is provided in Table 2 and Fig.…”

Section: Expected Normal Respondersmentioning

confidence: 99%

Is there a recommended maximum starting dose of FSH in IVF?

Rombauts

2007

J Assist Reprod Genet

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This report reviews and discusses the existing evidence on recommended FSH doses in IVF cycles. A comprehensive search for relevant data was performed in the Cochrane Library, MEDLINE, EMBASE and NICE clinical guidelines database, and the reference lists of manuscripts. A good body of evidence exists looking at starting doses of FSH for first IVF attempts. Only one randomised controlled trial was identified looking at the efficacy of increasing doses during an IVF cycle. Some observational studies dealt with the question whether a suboptimal ovarian response should be managed by an increased FSH dose in a subsequent cycle, but no randomised trials addressed this issue.

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“…In another study Ben-Rafael et al, [25] found fewer atretic oocytes (p< 0.05) and a higher pregnancy rate (22.8 versus 10.5%, not significant) in patients receiving two ampoules of HMG compared to those receiving three ampoules. Some studies comparing the use of two different doses of rFSH in antagonist cycles (150 vs 200 rFSH or 150 vs. 225 rFSH) found that the number of oocytes retrieved was higher using a higher dose of rFSH (p<0.05), but the proportion of high quality embryos and implantation rate were higher with the lower dose of rFSH (not significant) [26,27]. Out et al [22,28] comparing starting doses of 100 IU vs 200 IU rFSH or 150 IU vs. 250 IU rFSH in long agonist protocols also found higher pregnancy rates and implantation rates with the lowdose regimens, although differences were not statistically significant.…”

Section: Discussionmentioning

confidence: 99%

Mild IVF using GnRH agonist long protocol is possible: Comparing stimulations with 100 IU vs. 150 IU recombinant FSH as starting dose

Fernández-Shaw¹,

Esturo²,

R³

et al. 2009

J Assist Reprod Genet

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Purpose To test the possibility of stimulating ovaries with a mild IVF approach using a GnRH agonist long protocol. Methods Retrospective study of 142 first IVF cycles of women aged 30 to 35 who had undergone stimulation with 100 IU or 150 IU of rFSH. Results The mean dose of rFSH used was smaller in the low dose compared with the high dose group (999 vs. 1343 IU; p<0.001), obtaining comparable numbers of mature oocytes in both groups. Additionally, reducing the mean number of embryos transferred from 1.8 to 1.5 significantly decreased the twin rate in the low dose group while maintaining similar pregnancy rates in both groups. Conclusions It is possible to develop mild IVF using GnRH agonist long protocol in women with good prognosis. A reduced amount of rFSH and fewer transferred embryos allow for lower costs and risks of IVF without compromising the pregnancy rate.

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A prospective, randomized comparison of two starting doses of recombinant FSH in combination with cetrorelix in women undergoing ovarian stimulation for IVF/ICSI

Abstract: When using a starting dose of 225 IU rhFSH combined with the multiple dose of 0.25 mg cetrorelix from stimulation day 6, significantly more oocytes were obtained than with a starting dose of 150 IU rhFSH.

Cited by 75 publications

References 12 publications

The effects of GnRH analogs on serum and follicular fluid leptin levels and pregnancy outcomes in short protocols of assisted reproductive technology

The effects of GnRH analogs on serum and follicular fluid leptin levels and pregnancy outcomes in short protocols of assisted reproductive technology

Is there a recommended maximum starting dose of FSH in IVF?

Mild IVF using GnRH agonist long protocol is possible: Comparing stimulations with 100 IU vs. 150 IU recombinant FSH as starting dose

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