Repeat dose of gonadotropin-releasing hormone agonist trigger in polycystic ovarian syndrome undergoing In Vitro fertilization cycles provides a better cycle outcome - a proof-of-concept study

Krishna, Daida; Baiju, Pookilath; Gautham, Praneesh; Suvarna, R; Arveen, Vohra; Rao, Kamini A

doi:10.4103/jhrs.jhrs_102_17

Cited by 8 publications

(6 citation statements)

References 44 publications

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“…Polycystic ovary syndrome (PCOS) is a common endocrine metabolic syndrome in gynecological clinic, which is characterized by polycystic ovary, ovulation disorder and hyperandrogenemia [1,2]. It is generally believed that the incidence of PCOS is 5–10%, which is higher in adolescents and women of childbearing age [3,4]. In recent years, the incidence of polycystic ovary syndrome has been significantly increased.…”

Section: Introductionmentioning

confidence: 99%

Total flavonoids extracted from Nervilia Fordii function in polycystic ovary syndrome through IL-6 mediated JAK2/STAT3 signaling pathway

Zhou

Liu

et al. 2019

Bioscience Reports

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Large doses of flavonoids could cure many diseases with no serious side effects. However, the role of flavonoids in the treatment of polycystic ovary syndrome (PCOS) has not been reported. Therefore, total flavonoids extracted from Nervilia Fordii were selected to explore its therapeutic efficiency in PCOS. PCOS rat model was constructed to explore the role of total flavonoids in the treatment of PCOS. ELISA was used to assess the changes of ovulation function under the treatment of total flavonoids with or without exogenous interleukin-6 (IL-6). Western blot, real-time PCR and immunohistochemistry were carried out to assess the related molecular mechanisms. We explored that total flavonoids obviously increased the serum levels of follicle-stimulating hormone (FSH), and sharply decreased the serum levels of luteinizing hormone (LH), testosterone (T) and insulin (INS) in the PCOS-IR rats via partly inhibiting the activation of JAK2/STAT3 pathway, partially up-regulating the IL-6 expression and partially down-regulating the suppressor of cytokine signaling 3 (SOCS3) expression in ovaries of PCOS rats. The effect of total flavonoids on estrous cycles, serum levels of FSH, LH, T and INS were partially attenuated by IL-6 in PCOS rat model. Moreover, IL-6 significantly reversed the effect of total flavonoids on the phosphorylation of JAK2/STAT3, the expression of IL-6 and SOCS3 in ovaries of PCOS rats. Total flavonoids extracted from Nervilia Fordii might induce the expression of IL-6 in ovary and act as a potential therapeutic drug for the treatment of PCOS.

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Section: Introductionmentioning

confidence: 99%

Total flavonoids extracted from Nervilia Fordii function in polycystic ovary syndrome through IL-6 mediated JAK2/STAT3 signaling pathway

Zhou

Liu

et al. 2019

Bioscience Reports

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“…In our study, maturity rate, MI, MII, and GV oocytes were not statistically different between the two study groups, which question the proposed mechanism in repeat dose protocol. Moreover, the LH levels measured at 12 hr post-trigger predicted oocyte maturity in Deepika and colleagues study (16). But this relationship was not approved in our analysis.…”

Section: Discussionmentioning

confidence: 58%

“…This suboptimal response can be more probable in women with PCOS, a condition with hypothalamicpituitary-ovarian axis dysfunction. Deepika and colleagues claimed a repeat dose of GnRHa at this critical hour (12 hr) could preserve the amplitude and the duration of gonadotropin surge, thus optimizing the oocyte maturity (16). They obtained a significantly higher yield of MII oocytes along with a statistically significant lesser number of MIs and GV oocytes in the repeat dose group.…”

Section: Discussionmentioning

confidence: 99%

Does the repeat dose of gonadotropin-releasing hormone agonist trigger in polycystic ovarian syndrome improve in vitro fertilization cycles outcome? A clinical trial study

Aflatoonian

Haghighi

Hoseini

et al. 2020

IJRM

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Background: A repeat dose of Gonadotropin-releasing Hormone (GnRH) agonist could provide long duration of luteinizing hormone (LH) surge and amplitude appropriately. Objective: Improvement in oocyte maturity could be obtained by a repeat dose of GnRH agonist. Materials and Methods: In this randomized double-blinded study, 120 women with polycystic ovarian syndrome and serum estradiol level (E2) > 3000 who were candidate for in vitro fertilization with Antagonist protocol were enrolled between July 2018 and July 2019. Participants were randomized in two groups - and final oocyte maturation was triggered with two doses: In group A, a repeat dose of 0.1 mg, 12 hr. after the first dose and in group B, 0.2 mg SC triptorelin (decapeptyl) 35 hr. prior to oocyte retrieval. Serum Estradiol, LH, and progesterone concentration were measured on the trigger day. Serum LH measurement was done three times in both groups. The outcomes were oocyte yield, meiosis (M) I, MII, Maturity rate, germinal vesicle (GV) rate, 2 pronuclear, embryo yield, ovarian hyper stimulation syndrome rates. Results: Maturity rate (p = 0.89), MI (p = 0.38), MII (p = 0.89), and GV oocytes (p = 0.38) were not statistically different between the two study groups. LH levels measured at 12 hr post-trigger did not relate statistically significant with maturity rate in our participants (p = 0.96). No empty follicular syndrome was reported. Conclusion: Although the second dose of GnRH agonist after 12 hr since the first dose could provide duration of LH surge and amplitude and as a result no empty follicular syndrome was seen, the maturity rate, MI, MII, and GV oocytes were not different between the two study groups. Key words: Polycystic ovarian syndrome, Treatment, In vitro fertilization, Gonadotropin-Releasing hormone.

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“…The dose of estrogen was adjusted till the ET reached 8 mm. Luteal support was started with injection micronized progesterone 100 mg intramuscular/day, 3 days for cleavage embryos and 5 days 13 We divided into THREE groups with <15 as cut-off as 16.3% of our study subjects were in this category.…”

Section: Resultsmentioning

confidence: 99%

Impact of Two Doses of Agonist Trigger on Assisted Reproductive Technology Outcome

Vembu¹,

Nellepalli²,

Pandurangi³

et al. 2022

International Journal of Infertility &Amp; Fetal Medicine

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women in the age-group of 21-42 years, identified as hyperresponders by ovarian reserve markers, anti-Mullerian Hormone [AMH ≥3.5 ng/mL and or antral follicle count (AFC) of ≥20, >14 intermediary follicles and/or a high serum estradiol (E2) level (>3500 pg/mL] on the day of trigger, receiving two doses of agonist trigger 12-hour apart were included. Women with hypothalamic amenorrhea and hypogonadotropic-hypogonadism were excluded. So 86 women fulfilling the selection criteria were analyzed. Ovarian reserve assessment (determined by AMH levels, AFC on day 2 or 3 of menstrual cycle) was done after detailed history and clinical examination. IntroductIonHuman chorionic gonadotropin (hCG) has been used as a surrogate for mid-cycle luteinizing hormone (LH) surge to induce final follicular maturation. The long half-life of hCG can lead to the dreaded complication of ovarian hyper stimulation syndrome (OHSS). It is proposed that administration of GnRH agonist trigger to induce final oocyte maturation will reduce the risk of OHSS. 1 But the use of agonist trigger has been prevented by the fear and risk of some patients failing to respond adequately to this drug. 2 There is a risk of suboptimal response (defined by 12-hour LH post-trigger as <15 IU/L) 3 due to reduced release of gonadotropins during the surge. This necessitates the need to asses LH level and administer the second dose of agonist or low dose hCG. However, there is time lag in the availability of laboratory parameters in a short duration to take further steps in most of the ART settings. There is not enough of data to suggest the ART outcome and Live Birth Rate (LBR) following agonist trigger. With this in background, a study was conducted to assess the number of mature oocytes retrieved and oocyte maturation rate (OMR) following administration of second dose of GnRH agonist irrespective of serum LH levels and compare the ART outcome in women with different levels of LH, 12 hours post-trigger. MaterIals a n d Methods

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Repeat dose of gonadotropin-releasing hormone agonist trigger in polycystic ovarian syndrome undergoing In Vitro fertilization cycles provides a better cycle outcome - a proof-of-concept study

Cited by 8 publications

References 44 publications

Total flavonoids extracted from Nervilia Fordii function in polycystic ovary syndrome through IL-6 mediated JAK2/STAT3 signaling pathway

Total flavonoids extracted from Nervilia Fordii function in polycystic ovary syndrome through IL-6 mediated JAK2/STAT3 signaling pathway

Does the repeat dose of gonadotropin-releasing hormone agonist trigger in polycystic ovarian syndrome improve in vitro fertilization cycles outcome? A clinical trial study

Impact of Two Doses of Agonist Trigger on Assisted Reproductive Technology Outcome

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