Early and Short Follicular GnRH Antagonist (Sandwich) Protocol Versus Conventional GnRH Antagonist Protocol in Normal Responders

Abstract

Gonadotropin-releasing hormone antagonists are one of the GnRH analogs that were used in assisted reproductive technologies to produce prompt downregulation of pituitary gonadotropin secretion. During conventional antagonist protocol (CAP), exposure to high LH and E 2 occur that have the potential to worse clinical reproductive results. So the downregulation of pituitary secretion for short period during early follicular phase will result in synchrony in follicular developments and this will improve mature oocytes and total embryos numbers. 44 women as normal responders undergoing ICSI-ET cycles were randomized into two groups. The conventional group (CG) (n 30), gonadotropin started from menstrual cycle day 2 or 3 and continue until hCG trigger day, flexible protocol in which GnRH antagonists administered with follicular size (13-14 mm). In the sandwich group (SG) (n 14), a GnRH antagonist was administered for three days in which GnRH antagonists administered with follicular size (13-14 mm). Gonadotropin started from menstrual cycle day 3 and continue until hCG trigger day. Retrieved and MII oocyte mean numbers were significantly higher in SG than in CG (P = 0.006, and 0.025), respectively. Embryos and frozen embryos mean total numbers were significantly higher in SG than in CG (P = 0.004). SG patients have a higher pregnancy rate of 9/14 (64.3 %) than CG 12/30 (40.0 %) although not significant (P =0.057). Early and short GnRH antagonists proved improvements in synchronization of follicular development, retrieved mature oocytes numbers, total embryos, frozen embryos, and pregnancy rates.

Early administration of gonadotropin-releasing hormone antagonist versus flexible antagonist ovarian stimulation protocol in poor responders: a randomized clinical trial

“…Despite the large number of studies on poor ovarian response (POR) in assisted reproduction (ART) cycles in the last 20 years, there is still debate in determining the best and most effective protocol for controlled ovarian stimulation (COS) in patients with POR. Among the various COS methods, the administration of the gonadotropinreleasing hormone antagonist (GnRH-ant) regimen in poor responders has had numerous benefits such as decreased stimulation duration, decreased the total amount of gonadotropin required, no symptoms of hormonal withdrawal, and no ovarian cyst formation [1][2][3]. In contrast to treatment by GnRH agonist, the main advantage of using GnRH-ant in the treatment of poor responders is that it prevents the premature surge of luteinizing hormone (LH) with preserving pituitary gland responsiveness [2,4].…”

The Early Start of Gonadotropin-releasing Hormone Antagonist Versus Flexible Antagonist Ovarian Stimulation Protocol in Poor Responders: A Randomized Clinical Trial

“…Despite a large number of studies regarding poor ovarian response (POR) in assisted reproduction (ART) cycles in the last 20 years, there is still debate to determine the best and most effective protocol for controlled ovarian stimulation (COS) for these patients. Among the various methods of COS recently, the administration of gonadotropin-releasing hormone (GnRH-ant) regimen in poor responders had numerous bene ts with decreased stimulation duration and total amount of gonadotrophins required, without symptoms of hormonal withdrawal and no ovarian cyst formation (1)(2)(3) .The main advantage of applying the GnRH-ant in the treatment of poor responder is that it prevents premature surge of luteinizing hormone(LH) without decreasing the suppressive action on the pituitary gland as that observed with treatment by GnRH agonist (2,4).…”