Can we skip weekends in GnRH antagonist cycles without compromising the final outcome?

Bosch, Ernesto

doi:10.1016/j.fertnstert.2012.04.024

Cited by 5 publications

(3 citation statements)

References 10 publications

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“…The ultrashort flare GnRHa/GnRHant protocol is comprised of the administration of COCs started on days 2–5 of the menses continued for at least 7 days. COCs pretreatment was shown to result in a better synchronized response and a scheduled cycle on one hand, with significantly longer duration of the stimulation, higher gonadotropin consumption and a questionable lower ongoing pregnancy rate [ 3 , 13 , 14 ]. The detrimental effect of pretreatment COCs in the GnRH antagonist protocol was related to the potential negative effect of the gestagen component on the endometrium, or the low endogenous LH levels induced by COCs, with their deleterious impact on oocyte competence or endometrial receptivity [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

A simplified universal approach to COH protocol for IVF: ultrashort flare GnRH-agonist/GnRH-antagonist protocol with tailored mode and timing of final follicular maturation

Orvieto

2015

J Ovarian Res

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Recently, several new promising modifications have been introduced to clinical practice that may simplify and optimize IVF outcome. In the present opinion paper we present a simplified approach to controlled ovarian hyperstimulation protocol (COH), which combines the benefits of the ultrashort flare GnRH agonist/GnRH antagonist protocol and the personalized tailored mode and timing of ovulation triggering, aiming to improve IVF outcome while eliminating of severe OHSS.In patients at risk to develop severe ovarian hyperstimulation syndrome (OHSS), GnRH agonist (GnRHa) trigger if offered for final follicular maturation. While in those achieving ≥20 oocytes, the freeze all policy with the subsequent frozen-thawed embryo transfers (ET) is recommended, in those where less than 20 oocytes are retrieved, patients are re-evaluated 3 days after oocyte retrieval (day of ET) for signs of early moderate OHSS. If no early signs of OHSS developed, one embryo was transferred, and the patients are instructed to inject 1500 IU of HCG. In cases where signs of early moderate OHSS appear, the freeze all policy is recommended.In Patients not at risk to develop severe OHSS- three different modes of concomitant administration of both GnRHa and a standard bolus of hCG (5000–10,000 units) prior to oocyte retrieval were suggested. Standard hCG dose concomitant with GnRHa (dual trigger), 35–37 h before oocyte retrieval is offered to normal responders patients, resulting in improved oocyte/embryo quality and IVF outcome. GnRHa 40 h and standard hCG added 34 h prior to oocyte retrieval (double trigger), respectively are offered to patients demonstrating abnormal final follicular maturation despite normal response to COH. The double trigger results in significantly higher number of oocytes retrieved, higher proportions of the number of oocytes retrieved to the number of follicles >10 mm and >14 mm in diameter on day of hCG administration, higher number of MII oocytes and proportion of MII oocytes per number of oocytes retrieved, with the consequent significantly increased number of top-quality embryos, as compared to the hCG-only trigger cycles. Standard hCG dose concomitant with GnRHa (dual trigger), 34 h before oocyte retrieval should be offered to poor responders patients, aiming to overcome premature luteinization, while achieving high yield of mature oocytes.Further studies are required to support this new concept prior to its implementation as a universal COH protocol to IVF practice.

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Section: Introductionmentioning

confidence: 99%

A simplified universal approach to COH protocol for IVF: ultrashort flare GnRH-agonist/GnRH-antagonist protocol with tailored mode and timing of final follicular maturation

Orvieto

2015

J Ovarian Res

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“…9 This is because the stimulation starts on days 2 or 3 of menstrual cycle and this is an unpredictable event. 9 One way to avoid this is to use the oral contraceptive pill in the menstrual cycle before the start of the stimulation phase. 9 However, a meta-analysis found that pretreatment with oral contraceptive pill significantly reduced rates of ongoing pregnancy.…”

Section: Disadvantagesmentioning

confidence: 99%

“…9 One way to avoid this is to use the oral contraceptive pill in the menstrual cycle before the start of the stimulation phase. 9 However, a meta-analysis found that pretreatment with oral contraceptive pill significantly reduced rates of ongoing pregnancy. 9,10 Pretreatment with oestrogen is another method of programming the GnRH-antagonist cycles to tie in with the fertility clinics logistical needs 9 Increased risk of OHSS 7…”

Section: Disadvantagesmentioning

confidence: 99%

Acupuncture during ART

Szmelskyj

2015

Acupuncture for IVF and Assisted Reproduction

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The ultrashort flare GnRH-agonist/GnRH-antagonist protocol enables cycle programming and may overcome the “detrimental effect” of the oral contraceptive

Orvieto

2012

Fertility and Sterility

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Can we skip weekends in GnRH antagonist cycles without compromising the final outcome?

Cited by 5 publications

References 10 publications

A simplified universal approach to COH protocol for IVF: ultrashort flare GnRH-agonist/GnRH-antagonist protocol with tailored mode and timing of final follicular maturation

A simplified universal approach to COH protocol for IVF: ultrashort flare GnRH-agonist/GnRH-antagonist protocol with tailored mode and timing of final follicular maturation

Acupuncture during ART

The ultrashort flare GnRH-agonist/GnRH-antagonist protocol enables cycle programming and may overcome the “detrimental effect” of the oral contraceptive

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