Gonadotrophin releasing hormone antagonist in IVF/ICSI

M, Am; M, K Chaitanya

doi:10.4103/0974-1208.39594

Cited by 9 publications

(7 citation statements)

References 13 publications

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“…The literature regarding the cost effectiveness of GnRH antagonist protocols is currently contradictory. In a randomized trial by Badrawi et al [15], the cost of medication per cycle and per pregnancy was shown to be higher in a GnRH antagonist protocol than a GnRH agonist protocol, while an observational study by Kamath et al [16] found costs of the two protocols to be similar.…”

Section: Introductionmentioning

confidence: 99%

Optimal usage of the GnRH antagonists: a review of the literature

Copperman

Benadiva

2013

Reprod Biol Endocrinol

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Gonadotropin-releasing hormone (GnRH) antagonists, which became commercially available from 1999, have been used for the prevention of premature luteinizing hormone (LH) surges in controlled ovarian stimulation for in vitro fertilization or intracytoplasmic sperm injection. This review focuses on the recent literature on the use of GnRH antagonists and provides guidelines for optimal use in light of increasing evidence showing that GnRH antagonists are safe and effective, allowing flexibility of treatment in a wide range of patient populations. This includes patients undergoing first-line controlled ovarian stimulation, poor responders, and women diagnosed with polycystic ovary syndrome. The GnRH antagonist offers a viable alternative to the long agonists, providing a shorter duration of treatment with fewer injections and with no adverse effects on assisted reproductive technology outcome. This results in a significantly lower amount of gonadotropins required, which is likely to lead to improved patient compliance.

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Section: Introductionmentioning

confidence: 99%

Optimal usage of the GnRH antagonists: a review of the literature

Copperman

Benadiva

2013

Reprod Biol Endocrinol

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“…The rate of ‘confirmed OHSS’ requiring ICU admission per fresh IVF cycle has halved over recent years, from 0.06% in 1996-2006 to 0.03% in 2007-2019. This decline is likely to reflect the introduction of safer IVF practices including individualized dosing of gonadotropins for ovarian stimulation, using predictive markers such as AMH ( 15 , 21 ), and increased use of GnRH antagonist co-treated protocols ( 12 , 17 ). Furthermore, the reduced use of fresh embryo transfer cycles ( 13 , 14 ) from 82% in 2008 to 77% in 2019 ( 19 ), and the increased use of frozen embryo transfer (FET) may also have contributed to a reduction in OHSS requiring ICU admission ( 13 , 22 , 23 ).…”

Section: Discussionmentioning

confidence: 99%

“… Demographic data of female patients aged between 18-55 years presenting to an ICU in England, Wales or Northern Ireland. Data is collected from the ICNARC database ( 17 ) presented between the years 1996 to September 30 th , 2020. Data are presented as median (25 th quartile, 75 th quartile).…”

Section: Methodsmentioning

confidence: 99%

“…The numbers of ‘confirmed’ and ‘potential’ OHSS cases in 2020 were proportionately adjusted to account for the lack of availability of data between 1st October 2020 and 31st December 2020 at time of data-extraction. The number of ICUs from which the ICNARC database ( 17 ) collects data has increased significantly in recent years to now include all centres in England, Wales, and Northern Ireland (n=286; Supplementary Figure 1 ). Thus, a proportional uplift in the number of cases (termed ‘normalized’) according to the number of reporting centres was applied to account for lower number of ICUs reporting to ICNARC in the earlier years of the database.…”

Section: Methodsmentioning

confidence: 99%

“…Laboratory and clinical findings of patients requested from ICNARC, 1996-2020.Laboratory and clinical findings of female patients aged between 18-55 years presenting to an ICU in England, Wales, or Northern Ireland. The ICNARC database(17) does not collect the 'lowest' and 'highest' value recorded for all observational parameters. The medians and IQRs of these datasets have been presented.…”

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confidence: 99%

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Ovarian Hyperstimulation Syndrome (OHSS) requiring Intensive Care Unit (ICU) admission between 1996-2020 in England, Wales, and Northern Ireland

et al. 2022

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IntroductionOvarian Hyperstimulation Syndrome (OHSS) is a life-threatening iatrogenic complication of In vitro fertilisation (IVF). This study aimed to quantify rates of Ovarian Hyperstimulation Syndrome (OHSS) requiring intensive care unit (ICU) admission and assess whether trends have changed between 1996-2020 commensurate with the introduction of safer IVF practices.MethodsData regarding Intensive Care Unit (ICU) admission across England, Wales and Northern Ireland was gathered retrospectively from the Intensive Care National Audit and Research Centre (ICNARC) database. 38,957 female patients aged between 18-55 years were admitted to ICU for OHSS or related conditions between 1996-2020. The primary outcome was the rate of OHSS requiring ICU admission expressed as a proportion of the number of fresh IVF cycles conducted in that year according to Human Fertility and Embryology Authority (HFEA) records. Baseline characteristics (for example, age, ethnicity, BMI), biochemical parameters (such as renal function, serum electrolytes), length of ICU stay and duration and need for organ support, were also compared between ICU patients with ‘confirmed OHSS’ and those ‘without OHSS’.ResultsThere were 238 cases of ‘confirmed OHSS’ requiring ICU admission recorded between 1996-2020. Rates of OHSS requiring ICU admission declined over the study period (P=0.006); the annual rate of severe OHSS requiring intensive care admission halved when comparing those occurring between 1996-2007 and 2008-2020 (OR=0.37, 95% CI 0.37-0.45; P<0.0001). Patients spent a mean of 3.5 days in the ICU, with 86.3% of patients with ‘confirmed OHSS’ requiring at least 2 days of higher level (i.e., level 2 or 3) care. Patients with ‘confirmed OHSS’ required a shorter duration of renal, advanced cardiovascular, and advanced respiratory support than patients ‘without OHSS’ (P<0.0001 for all comparisons). There was no significant difference in BMI or ethnicity between those with ‘confirmed OHSS’ and those ‘without OHSS’, however women with ‘confirmed OHSS’ were younger (34 versus 41 years old, p<0.0001).DiscussionAlthough absolute rates of OHSS requiring ICU admission recorded in this study are likely to represent a significant underestimate of all clinically significant OHSS, rates of OHSS requiring ICU admission have decreased since 1996 in concordance with the introduction of modern IVF practices.

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Ovarian Hyperstimulation Syndrome

Mathur¹

2015

Reducing Risk in Fertility Treatment

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Gonadotrophin releasing hormone antagonist in IVF/ICSI

Cited by 9 publications

References 13 publications

Optimal usage of the GnRH antagonists: a review of the literature

Optimal usage of the GnRH antagonists: a review of the literature

Ovarian Hyperstimulation Syndrome (OHSS) requiring Intensive Care Unit (ICU) admission between 1996-2020 in England, Wales, and Northern Ireland

Ovarian Hyperstimulation Syndrome

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