A randomized prospective study of microdose leuprolide versus ganirelix in in vitro fertilization cycles for poor responders

Objective To determine whether concentrations of oxidative stress markers of follicular fluid and serum are different in GnRH agonist protocol from GnRH antagonist protocol. Material and method This was a cross-sectional study. Eighty-four women undergoing controlled ovarian stimulation with either GnRH agonist (n039) or GnRH antagonist protocols (n045) for IVF/ICSI treatment were assigned by a physician. Blood was obtained at the time of oocyte retrieval, and follicular fluid (FF) from the mature follicles of each ovary was centrifuged and frozen until analysis. Malondialdehyde (MDA), nitric oxide (NO), protein carbonyl (PC), hydroxyl proline (OH-P), sodium oxide dismutase (SOD), reduced glutathione (GSH), glutathione peroxidase (GSH-Px), adenosine deaminase (ADA) and xanthine oxidase (XO) were assessed in the serum and follicular fluid of each participants. ResultsThe mean serum concentrations of GSH-Px, GSH and MDA were lower in the GnRH antagonist group compared to GnRH agonist group, but mean serum SOD was higher in the GnRH antagonist group. The mean follicular SOD, ADA and NO were higher in GnRH antagonist group than GnRH agonist group. The IVF/ICSI outcomes were similar in both groups. Conclusion(s) GnRH antagonist protocol is associated with increased oxidative stress. The relation of GnRH analogues with oxidative stress and its implication in follicular growth needs to be addressed in further studies.

Section: Introductionmentioning

confidence: 99%

A comparative study on oxidative and antioxidative markers of serum and follicular fluid in GnRH agonist and antagonist cycles

Çelik

Kumbak

et al. 2012

“…Nowadays, assisted reproductive technology (ART) is so popular in treatment of infertility, but the main problem in these methods is treatment of poor responder patients [1]. The rates of poor ovarian responses to the stimulation have been reported from 9% to 24% [2,3] leading to a low pregnancy rate in these patients (about 2%-4%) [4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

“…This produced this question for researchers whether adding E2 to P supplementation could improve implantation rate or not [19]. Furthermore, most of the previous studies which reached positive effects of luteal phase E2 administration were designed for patients with a good ovarian response [7,18,20]. This controlled randomized clinical trial is designed to …”

Section: Introductionmentioning

confidence: 99%

Estradiol supplementation during the luteal phase in poor responder patients undergoing in vitro fertilization: a randomized clinical trial

Aghahosseini

Aleyassin

Khodaverdi

et al. 2011

Purpose This study was designed to evaluate the effects of adding Estradiol (E2) supplementation to progesterone (P) on improvement of pregnancy outcomes in poor responder patients who underwent in vitro fertilization (IVF).Methods In a prospective randomized clinical trial, 118 poor responder patients, older than 38 years without contraindications of estradiol consumption from Infertility clinic of a university hospital were randomly divided (by computerized software) into two groups. Control group (59 patients) received only P and intervention group (59 patients) received P and E2 (4 mg/d). Supplementation was done with 4 mg E2 in the luteal phase. Fertilization rate, implantation rate, biochemical and clinical pregnancy rates, abortion rate, ongoing pregnancy, multiple pregnancy and ectopic pregnancy rates were documented for those who completed the study protocol in each group (per protocol analysis) and compared between groups. Result Fifty five patients in control group and 53 patients in intervention group successfully completed the study protocol. Treatment outcomes were not significantly different between two groups. Conclusion For poor responder women who underwent IVF, addition of E2 to P supplementation could not significantly improve pregnancy outcomes.

“…Although the prognosis for these women is guarded, leading some to consider other options such as egg donation or adoption, various adjunctive measures have been suggested to improve the ovarian response to gonadotropins. Since there is little evidence to support gonadotropin doses over 450-600 IU/day [1], current approaches have included the addition of oral agents such as clomiphene citrate [2,3] or letrazole [4][5][6][7][8][9], the administration of GnRH antagonists instead of agonists [10][11][12], microdose GnRH agonist "flare" [6,13] and other agents such as growth hormone (GH) [14] and most recently the suggestion that DHEA may be helpful [15].…”

Section: Introductionmentioning

confidence: 99%

Does the addition of clomiphene citrate or letrazole to gonadotropin treatment enhance the oocyte yield in poor responders undergoing IVF?

Jovanovic

Kort

Guarnaccia

et al. 2011

Purpose To evaluate the effect of adjunctive letrazole or clomiphene in IVF stimulation protocols. Methods A retrospective analysis of high dose GnRH antagonist IVF cycles (450-600 IU of gonadotropins) that have met poor responder criteria. Selected consecutive cycles in same patients differed solely in presence or absence of adjunctive clomiphene or letrazole. Results Supplementation with clomiphene citrate in poor responders showed significant improvements (p<0.05) in estradiol levels (1506 vs. 1044 pg/ml), number of dominant follicles (5.6 vs. 3.9), oocytes retrieved (5.2 vs. 3.4) and number of transferred embryos (1.7 vs. 1.1). It significantly improved biochemical pregnancy rates (18.1% vs. 5.9%) while reducing cycle cancellations (11.7% vs. 32.6%). Letrozole supplementation showed similar effects. Conclusion Both Clomiphene and Letrazole performed similarly and showed significant effects. However, despite increasing oocyte yield and embryo transfer rates, the overall clinical and live birth rate in this population remained low and showed no measurable increase.