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

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 in vitro fertilization (IVF) cycle outcome in reproductive women. The characteristics of treatment and outcomes of pregnancy were retrospectively compared between the antagonist (GnRH-A, antagonist group) and agonist (GnRH-a, agonist group) regimens. The area under the curve (AUC) of receiver operating characteristic (ROC) curves was also used to evaluate whether the endometrial thickness (cm), progesterone (P) level (ng/ml) and estradiol (E 2) level (pg/ml) on the day of human chorionic gonadotropin (hCG) administration (hCG day) had the ideal sensitivity and specificity for predicting clinical pregnancy. There were no significant differences in the baseline profiles of luteinizing hormone, E 2 and P between the GnRH-A and GnRH-a groups (P=0.646, 0.224 and 0.119, respectively). However age, body mass index and follicle stimulating hormone (FSH) level significantly differed between the two groups (P<0.001, =0.025 and <0.001, respectively). Regarding treatment, there were significant differences in the stimulation duration (recombinant FSH days of usage), dose of gonadotrophins, E 2 , and P levels on hCG day, endometrial thickness on hCG day, mean number of total oocytes retrieved, mean number of two pronuclei oocytes, mean number of embryos available and mean number of embryos transferred (all P<0.001). The rate of clinical pregnancy was lower with the GnRH antagonist than with the GnRH agonist (P<0.001). Additionally, the live birth rate in the GnRH-A group was significantly lower than that in the GnRH-a group (P<0.001). The rate of ectopic pregnancy did not differ significantly between the treatment groups (P=0.840). However, the rate of ovarian hyperstimulation syndrome (OHSS) in group GnRH-A was significantly lower than that in group GnRH-a (P=0.039). Therefore, in the present series of patients who underwent IVF embryo transfer cycles, a GnRH antagonist protocol was associated with significantly lower rates of clinical pregnancy and live birth compared with a GnRH agonist protocol; however, the rate of OHSS was significantly lower with GnRH antagonist compared with GnRH agonist. Furthermore, the results of the influence of endometrial thickness on clinical pregnancy, based on the ROC curve (AUC), demonstrated that the AUC was 0.553 [95% confidence interval (CI): 0.521-0.585], and with a cutoff of 9.25 cm, the Youden index [sensitivity-(1-specificity)] was 0.085. The results of the influence of E 2 level on hCG day on the clinical pregnancy rate revealed an AUC of 0.613 (95% CI: 0.581-0.644), and with a cutoff of 1,520 pg/ml, the Youden index was 0.184. The results of the influence of P level on hCG day (ng/ml) on the clinical pregnancy rate revealed an AUC of 0.526 (95% CI: 0.494-0.558), and with a cutoff of 0.415 ng/ml, the Youden index was 0.061. These results of the ROC curve analyses demonstrated that neither the endometrial thickness nor the E 2 and P levels on...

A retrospective study in Chinese infertility patients to investigate pregnancy outcomes of gonadotropin-releasing hormone antagonist in in vitro fertilization/intracytoplasmic sperm injection cycles: The FASSION study

“…A total of 51 (1.7%) out of 2972 patients experienced OHSS with mild (0.8%), moderate (0.3%) or severe (0.6%) intensity. A similar incidence of OHSS (1.21%) was reported in a recent retrospective study with Chinese women treated with a GnRH antagonist protocol [30]. The freeze-all policy was implemented as a prevention of OHSS in 14.9% of patients who presented signs, symptoms or risk of OHSS.…”

Live birth rate comparison of three controlled ovarian stimulation protocols for in vitro fertilization-embryo transfer in patients with diminished ovarian reserve after endometrioma cystectomy: a retrospective study

“…In our study, we found lower treatment time and pharmaceutical use in the GnRH-antagonist protocol. This protocol has therefore become widespread and is an indispensable part of ovarian stimulation in IVF due to lower risk of ovarian hyperstimulation syndrome (OHSS) and its function as preventing premature luteinization, which is essential for normal follicular development and oocyte maturation [40]. For pituitary desensitization, both daily administration of GnRHagonist and immediately blocking the secretion of LH with GnRH-antagonist can effectively block premature LH surges.…”

General Issues in Clinical Research of Acupuncture and In Vitro Fertilization

“…What needs to be verified is whether acupuncture can improve the success rate of IVF. erefore, the IVF scheme should be unified relatively, because different IVF schemes, such as different follicular induction schemes, have different pregnancy rates [27].…”