Effectiveness of GnRH antagonist in intrauterine insemination cycles

Kamath, Mohan S; Ramya, R; Bhave, Priya; Muthukumar, K; Aleyamma, TK; George, Kuryan

doi:10.1016/j.ejogrb.2012.09.023

Cited by 10 publications

(24 citation statements)

References 18 publications

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“…There was no case of OHSS in either group. Study by Cantineau et al [19,20] and Kamath et al [10] also did not show any significant difference with or without GnRH antagonist use. There were three cases in the control group and one case in the antagonist group of mild OHSS, and all were in cycles that resulted in pregnancy.…”

Section: Mild Ovarian Hyperstimulation (Moh) Is Defined As the Adminimentioning

confidence: 82%

“…This could be due to the fact that these studies started using GnRH antagonist when the follicle reached 14 mm, whereas in our study it was started when the follicle reached 16 mm. Study by Kamath et al [10], Bakas et al [11] and Gomez-Palomares et al [12] used antagonist at follicle size of 16 mm. In our study no premature LH surge had occurred in either group when the follicle was C16 mm concluding that it is safe to administer GnRH antagonist with IUI on day till follicle reaches 16 mm.…”

Section: Mild Ovarian Hyperstimulation (Moh) Is Defined As the Adminimentioning

confidence: 99%

“…According to a study conducted by Kamath et al [10], the incidence of premature LH surge and premature luteinisation was lower in the antagonist group as compared to the control group not receiving GnRH antagonist In a study conducted in 2006, Lambalk et al [13] evaluated the role of the GnRH antagonist (ganirelix) in the treatment of subfertile couples. This study revealed that the incidence of LH surge ([10 mIU/ml) was lower in the group receiving GnRH antagonist (ganirelix) compared with the control group receiving only rFSH.…”

Section: Mild Ovarian Hyperstimulation (Moh) Is Defined As the Adminimentioning

confidence: 99%

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Evaluation of Role of GnRH Antagonist in Intrauterine Insemination (IUI) Cycles with Mild Ovarian Hyperstimulation (MOH): A Prospective Randomised Study

Wadhwa

Khanna

Gupta

et al. 2016

J Obstet Gynecol India

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Aims and Objective To evaluate the role of GnRH antagonist in prevention of premature LH surge and increasing pregnancy rates in IUI cycle with mild ovarian hyperstimulation (MOH). Study Design Prospective parallel, randomised controlled study. Material and Methods Couples diagnosed with unexplained, male factor subfertility and with one or both tubes patent were randomised to receive either a GnRH antagonist (study group) or no intervention (control group 123 women were treated with clomiphene citrate (D3-D7) followed by HMG. A GnRH antagonist was added when one or more follicles of 16 mm diameter or more were visualised in the study group. When at least one follicle reached a size of C18 mm, ovulation was induced by hCG injection. A single IUI was performed 36 h later. The primary outcome was premature LH surge and pregnancy rate. The secondary outcomes were the amount of gonadotropins used, duration of use of GnRH antagonist and incidence and severity of OHSS. Results A total of seventy patients attending the infertility clinic in the outpatient department of Obstetrics and Gynecology, of a tertiary care centre, were recruited in the study which was carried out from August 2011 to March 2013. The study group included 34 women and 36 in the control arm. The incidence of premature LH surge was significantly lower in the antagonist group as compared to the control group 2.9 vs. 13.9 %, with a p value of \0.001. The clinical pregnancy rates were similar in both the groups 8.8 vs. 11.1 %, p value being 1.000. The amount of gonadotropins used in GnRH antagonist group was lower than in control group but not statistically significant. Duration of GnRH antagonist was 1.85 ± 0.61 days in the study group. Conclusion The delayed administration of GnRH antagonists in MOH with IUI cycles when follicle size is C16 mm is beneficial in terms of preventing the occurrence of premature LH surge but with no improvement in pregnancy rates.

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Section: Mild Ovarian Hyperstimulation (Moh) Is Defined As the Adminimentioning

confidence: 82%

Section: Mild Ovarian Hyperstimulation (Moh) Is Defined As the Adminimentioning

confidence: 99%

Section: Mild Ovarian Hyperstimulation (Moh) Is Defined As the Adminimentioning

confidence: 99%

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Evaluation of Role of GnRH Antagonist in Intrauterine Insemination (IUI) Cycles with Mild Ovarian Hyperstimulation (MOH): A Prospective Randomised Study

Wadhwa

Khanna

Gupta

et al. 2016

J Obstet Gynecol India

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“…Although earlier investigations have shown the benefits of these molecules, (6,(15)(16)(17)(18) subsequent studies have failed to confirm them. (19)(20)(21)(22) In 2005, Gómez-Palomares et al concluded from their prospective randomised study that the addition of GnRH antagonists to COH + IUI cycles significantly increased pregnancy rates. (15) In 2008, another study by the same authors reported that the markedly better pregnancy rates seen in patients who were administered GnRH antagonists could be due to the multifollicular development of mature (> 18 mm) follicles, as GnRH antagonists allow for the growth of intermediate follicles without the risk of premature luteinisation.…”

Section: Discussionmentioning

confidence: 99%

“…(21) In fact, a recent trial evaluating the effectiveness of GnRH antagonists in IUI cycles was discontinued because of the lower pregnancy rates observed in the GnRH antagonist group. (22) Similarly, the 2011 Cochrane review on ovarian stimulation protocols for IUI cycles did not reach a definite conclusion on the use of GnRH antagonists; while the use of GnRH antagonists was not advised in mild COH cycles, it was recommended that the utility of GnRH be determined in future trials. (10) In the present study, we were not able to prove the benefits of GnRH antagonists in clinical pregnancy rates.…”

Section: Discussionmentioning

confidence: 99%

Effect of GnRH antagonists on clinical pregnancy rates in ovulation induction protocols with gonadotropins and intrauterine insemination

Dansuk¹,

Gönenç²,

Sudolmus³

et al. 2015

smedj

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INTRODUCTIONIntrauterine insemination (IUI) is widely used as an infertility treatment modality. The success of assisted reproductive technologies is dependent on appropriate patient selection and adequate development of oocytes. Compared to clomiphene citrate ovarian stimulation, gonadotropin ovarian stimulation with IUI results in higher pregnancy rates. Moreover, the combination of controlled ovarian hyperstimulation (COH) + IUI has been shown to increase the fecundity of the cycle as compared to IUI alone.(1,2) There are variations in the reported clinical pregnancy rates of COH + IUI cycles; these may be attributed to differences in the aetiology and duration of infertility, sperm preparation technique, the number of sperms injected, the number of inseminations per cycle, cycle monitoring, IUI timing and the ovarian stimulation protocol selected. (2)(3)(4)(5) Although low-dose protocols with recombinant folliclestimulating hormone (rFSH) are used during COH + IUI cycles, (6) multifollicular development may occur and result in a sudden increase in serum estradiol (E2) levels, which can result in a premature luteinising hormone (LH) peak (before follicular maturation) and revocation of the IUI.(7) Gonadotropin-releasing hormone (GnRH) analogues lead to the desensitisation of pituitary GnRH receptors and, via this phenomenon, block endogenous LH increase. The use of GnRH analogues has been reported to lower premature LH peak to approximately 2% and subsequently increase pregnancy rates.(8) For more than ten years, the use of gonadotropins with GnRH agonists has been the most frequently applied treatment protocol for reducing the incidence of premature LH peak.(9) However, this treatment protocol, which needs 2-3 weeks of desensitisation time, also increases the amount of gonadotropins used, the risk of ovarian hyperstimulation syndrome and the duration of treatment. During the desensitisation period, patients are also exposed to side effects such as hot flushes, headaches, vaginal dryness and bleeding. These drawbacks have resulted in the recent removal of IUI treatment protocols, including GnRH agonists. A Cochrane review on ovarian stimulation protocols for IUI advised against the use of GnRH agonists in COH with low-dose exogenous FSH (i.e. mild COH). (10) GnRH antagonists, which are produced through the exchange of amino acids of GnRH with other molecules at multiple points, bind to GnRH receptors with high affinity.(11) These antagonistic molecules prevent the release of endogenous gonadotropin and are currently being considered to replace GnRH agonists due to their positive pharmacokinetic and pharmacodynamic properties. The advantages of GnRH antagonists include absence of the first flare-up effect, reduced risk of oestrogen deficiency syndrome (since there is no need for long-term desensitisation), sufficient LH blockage in a short duration of time, dose-dependent effect

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Agents for ovarian stimulation for intrauterine insemination (IUI) in ovulatory women with infertility

Cantineau

Rutten

Cohlen

2021

Cochrane Database of Systematic Reviews

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Effectiveness of GnRH antagonist in intrauterine insemination cycles

Cited by 10 publications

References 18 publications

Evaluation of Role of GnRH Antagonist in Intrauterine Insemination (IUI) Cycles with Mild Ovarian Hyperstimulation (MOH): A Prospective Randomised Study

Evaluation of Role of GnRH Antagonist in Intrauterine Insemination (IUI) Cycles with Mild Ovarian Hyperstimulation (MOH): A Prospective Randomised Study

Effect of GnRH antagonists on clinical pregnancy rates in ovulation induction protocols with gonadotropins and intrauterine insemination

Agents for ovarian stimulation for intrauterine insemination (IUI) in ovulatory women with infertility

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