Long gonadotropin-releasing hormone agonist versus short agonist versus antagonist regimens in poor responders undergoing in vitro fertilization: a randomized controlled trial

Sunkara, Sesh Kamal; Coomarasamy, Arri; Faris, Raef; Braude, Peter

doi:10.1016/j.fertnstert.2013.09.035

Cited by 97 publications

(73 citation statements)

References 30 publications

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“…While there may be criticism on the use of long agonist protocol for predicted poor responders in our study, instead of short agonist or antagonist protocol, there is no evidence to support the use of one particular protocol to another in women with low ovarian reserve (46)(47)(48)(49). In fact, one recent RCT has shown an improved ovarian response with the use of long protocol compared to short agonist protocol and similar response in comparison to antagonist protocol (49).…”

Section: Discussionmentioning

confidence: 58%

“…In fact, one recent RCT has shown an improved ovarian response with the use of long protocol compared to short agonist protocol and similar response in comparison to antagonist protocol (49). Further, this study was planned to minimally disrupt our standard clinical practice and the NURTURE fertility clinic has been using the long agonist protocol for the majority of patients with satisfactory live birth rates of 37.3%, 13.3% in women aged 38-39 and 40-42, respectively (50).…”

Section: Discussionmentioning

confidence: 99%

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Efficacy of Dehydroepiandrosterone (DHEA) to overcome the effect of ovarian ageing (DITTO): A proof of principle double blinded randomized placebo controlled trial

Narkwichean

Maalouf

Baumgarten

et al. 2017

European Journal of Obstetrics & Gynecology and Reproductiv

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Objective: To evaluate the effect of DHEA supplementation on In-Vitro Fertilisation (IVF) outcome as assessed by ovarian response, oocyte developmental competence and live birth rates in women predicted to have poor ovarian reserve (OR). The feasibility of conducting a large trial is also assessed by evaluating the recruitment rates and compliance of the recruited participants with DHEA/placebo intake and follow-up rates. Study design:A single centre, double blinded, placebo controlled, randomized trial was performed over two years with 60 women undergoing in-vitro fertilisation (IVF). Subjects were randomized, based on a computer-generated pseudo-random code to receive either DHEA or placebo with both capsules having similar colour, size and appearance. 60 women with poor OR based on antral follicle count or anti-Mullerian hormone thresholds undergoing IVF were recruited. They were randomised to receive DHEA 75 mg/day or placebo for at-least 12 weeks before starting ovarian stimulation. They had long protocol using hMG 300 IU/day. Data analysed by "intention to treat". Ovarian response, live birth rates and molecular markers of oocyte quality were compared between the study and control groups. Results:The recruitment rate was 39% (60/154). A total of 52 participants (27 versus 25 in the study and placebo groups) were included in the final analysis after excluding eight. While the mean (standard deviation) DHEA levels were similar at recruitment (9.4 (5) versus 7.5 (2.4) ng/ml; P = 0.1), the DHEA levels at pre-stimulation were higher in the study group than in the controls (16.3 (5.8) versus 11.1 (4.5) ng/ml; P < 0.01). The number (median, range) of oocytes retrieved (4, 0-18 versus 4, 0-15 respectively; P = 0.54) and live birth rates (7/27, 26% versus 8/25, 32% respectively; RR (95% CI): 0.74 (0.22-2.48) and mRNA expression of developmental biomarkers in granulosa and cumulus cells were similar between the groups. Conclusion:Pre-treatment DHEA supplementation, albeit statistical power in this study is low, did not improve the response to controlled ovarian hyperstimulation or oocyte quality or live birth rates during IVF treatment with long protocol in women predicted to have poor OR.

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Section: Discussionmentioning

confidence: 58%

Section: Discussionmentioning

confidence: 99%

Efficacy of Dehydroepiandrosterone (DHEA) to overcome the effect of ovarian ageing (DITTO): A proof of principle double blinded randomized placebo controlled trial

Narkwichean

Maalouf

Baumgarten

et al. 2017

European Journal of Obstetrics & Gynecology and Reproductiv

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“…However, a low number of oocytes after such stimulation may constitute a normal response, resulting in low pregnancy rate, that's what concluded from randomized controlled trial study design done by some group when compared the efficacy of the long GnRH agonist vs. the short GnRH agonist vs. the GnRH antagonist regimens in poor responders undergoing IVF (16) .Gonadotropin-releasing hormone (GnRH) antagonist and short agonist stimulation protocol has shorter duration of treatment and less gonadotropin use, table (2). GnRH long agonist protocol is better in folliculogenesis and pregnancy rate, which is the imperative goal of COH.…”

Section: Results:-mentioning

confidence: 96%

Effect of Different Controlled Ovarian Hyper-Stimulation Protocols on Endometrial Receptivity Parameters of Icsi Programs.

Rahmatullah¹,

Obaidi²,

Saadi³

et al. 2017

IJAR

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Background:Infertility is defined by demographers as childlessness in a population of women at a reproductive age, currently, female fertility normally reaching the peak at age of 24 years and declines after the age of 30-32. Age, overweight, smoking, abnormal pituitary-ovarian hormones all are considered as risk factors of infertility. IVF technique was to overcome this condition by using patients' oocytes and sperms. A good number of high quality oocytes are required for maximizing the success rates with IVF cycles, since success rates correspond to the number of retrieved oocytes. Gonadotropic releasing hormones used for suppression of pituitary hormones with exogenous Gonadotropic hormones administration can achieve multifollicular stimulation in different protocols. Objective: Comparing the effect of different controlled ovarian hyperstimulation protocols on the endometrial receptivity markers. Methods: A total of eighty patients undergoing IVF/ICSI cycle were evaluated. One out of three types of controlled ovarian hyperstimulation (COH) protocols had been chosen for each patient according to her age, history and hormonal assay. At day of embryo transfer blood sample was taken to measure the level of VEGF, also Doppler ultrasonography to measure the resistance index (RI), pulsatility index (PI), systolic velocity/diastolic velocity (V S /V d ) was done. Results: There were no significant difference between the three types of ovarian stimulation protocols, still the picture drawn suggests that GnRH antagonists are slightly less efficacious than GnRH agonists in long protocols. Conclusion: Different types of controlled ovarian hyperstimulation protocols have no significant effects on endometrial receptivity parameters.

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“…Another limitation might be the existence of two conventional protocols, representing the control group. This could be justified by the standard policy of our Unit to use both protocols for this category of patients and due to the fact that both protocols appear to be equal in terms of success rates when applied to poor responders (5,8,9,37). We also fully acknowledge the difference in terms of oocyte quality and quantity when stimulated between poor responders at a young and advanced age, or those with different phenotypes: again here, the sample size warranted would be much higher and the conducting of this study much longer.…”

Section: Discussionmentioning

confidence: 99%

Mild Versus Conventional Ovarian Stimulation for Poor Responders Undergoing IVF/ICSI

Siristatidis

Salamalekis

Dafopoulos

et al. 2017

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Long gonadotropin-releasing hormone agonist versus short agonist versus antagonist regimens in poor responders undergoing in vitro fertilization: a randomized controlled trial

Cited by 97 publications

References 30 publications

Efficacy of Dehydroepiandrosterone (DHEA) to overcome the effect of ovarian ageing (DITTO): A proof of principle double blinded randomized placebo controlled trial

Efficacy of Dehydroepiandrosterone (DHEA) to overcome the effect of ovarian ageing (DITTO): A proof of principle double blinded randomized placebo controlled trial

Effect of Different Controlled Ovarian Hyper-Stimulation Protocols on Endometrial Receptivity Parameters of Icsi Programs.

Mild Versus Conventional Ovarian Stimulation for Poor Responders Undergoing IVF/ICSI

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