GnRH antagonist for patients with polycystic ovary syndrome undergoing controlled ovarian hyperstimulation for in vitro fertilization and embryo transfer in fresh cycles

Abstract

Abstract. The aim of the present study was to evaluate the influence of a gonadotropin-releasing hormone (GnRH) antagonist compared with a GnRH agonist on the in vitro fertilization cycle outcome in patients with polycystic ovary syndrome. The outcomes of pregnancy were evaluated. The area under the curve (AUC) of the receiver operating characteristic (ROC) curve was also used to evaluate whether the endometrial thickness (cm) and estradiol (E 2 ) level (pg/ml) on the day of human chorionic gonadotropin (hCG) administration (the hCG day) had the best sensitivity and specificity for predicting a clinical pregnancy. The results demonstrated that there were significant differences in the E 2 and progesterone levels between the two treatment groups on the hCG day. Furthermore, the mean number of total oocytes retrieved, mean number of 2 pronuclei oocytes, mean number of oocytes cleaved (P<0.05), mean number of embryos available (P=0.022) and mean number of embryos transferred (P=0.014) were significantly different. Additionally, the rates of ectopic pregnancy (P=0.984) and ovarian hyperstimulation syndrome (P= 0.976) did not differ significantly between the treatment groups. Although the biochemical pregnancy (P=0.592), clinical pregnancy (P=0.617) and live birth (P=0.365) rates were lower with the GnRH antagonist than with the GnRH agonist, there were no significant differences in the outcomes between the two groups. Analysis of the influence of endometrial thickness with respect to the clinical pregnancy using the ROC (AUC) method revealed that when the best cutoff of 9.75 cm was used, the sensitivity was 62.5%, the specificity was 43.1% and the AUC was 0.53. Additionally, the Youden index was 0.056. Analysis of the influence of the E 2 level on the hCG day on clinical pregnancy, using the ROC (AUC) method showed that the best cutoff was 2,984.5 pg/ml, which had a sensitivity of 68.8% and specificity of 52.9%, while the AUC was 0.573 (with a Youden index of 0.217). Furthermore, the results demonstrated that neither the endometrial thickness nor the E 2 level on the hCG day had the best sensitivity and specificity for predicting a clinical pregnancy.

Influence of GnRH antagonist in reproductive women on in�vitro fertilization and embryo transfer in fresh cycles

“…However, the risk of OHSS was lower with the GnRH antagonist. In the present study, the results of the ROC curves demonstrated that neither E 2 nor P level on the day of hCG administration had ideal sensitivity or specificity for predicting clinical pregnancy, in accordance with our previous study (10). Therefore, it appears that in predicting clinical pregnancy rate, the endometrial thickness and estradiol and progesterone levels are not the ideal predictors.…”

“…When antagonists have been used in patients with normal ovarian function, the clinical pregnancy rate has been reported as lower than that for the agonist protocol, potentially due to the antagonist exerting a negative effect directly or indirectly on endometrial receptivity, for instance by promoting premature maturation of the endometrium (16)(17)(18). It is undesirable that in the present study, there were significant differences in the baseline parameters of age, BMI and FSH hormone profile between the GnRH-A and GnRH-a groups, which differed from similar previous study by our group on polycystic ovary syndrome (10). Cumulative studies have confirmed that an association exists between age and fertility; ovarian aging and reduced ovarian reserve are considered critical factors in determining IVF outcomes (19)(20)(21).…”

“…All of the patients underwent baseline transvaginal sonography on day 2 or 3 of the menstrual cycle to check the antral follicle count and the thickness of the endometrium (cm). The protocol for agonist and antagonist treatments were as reported previously (10). Outcomes including the mean number of total oocytes retrieved, the mean number of two pronuclei (2PN) oocytes, the mean number of embryos available, the mean number of embryos transferred and live birth rate (11)(12)(13) were recorded.…”

Do basal luteinizing hormone and luteinizing hormone/follicle-stimulating hormone ratio have significance in prognosticating the outcome of In vitro fertilization cycles in polycystic ovary syndrome?

“…[ 16 ] The GnRH antagonist has thus presented the IVF-ET a patient-friendly and safe procedure with high efficacy. [ 17 ]…”