Use of a luteal estradiol patch and a gonadotropin-releasing hormone antagonist suppression protocol before gonadotropin stimulation for in vitro fertilization in poor responders

Dragisic, Katherine G.; Davis, Owen K.; Fasouliotis, Sozos J.; Rosenwaks, Zev

doi:10.1016/j.fertnstert.2005.04.031

Cited by 103 publications

(84 citation statements)

References 20 publications

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“…They showed better outcomes, as compared to outcomes in previous cycles, for patients undergoing stimulation with the luteal E2 patch/GnRH antagonist protocol [16] Shastri et al compared the in vitro fertilization (IVF) results for young poor responders treated in a luteal estradiol/gonadotropin-releasing hormone antagonist protocol with the results of a micro dose protocol. The patients in the E2/antagonist group had a greater gonadotropin necessity and a lower E2 level.…”

Section: Discussionmentioning

confidence: 99%

A comparative study of luteal estradiol pre-treatment in GnRH antagonist protocols and in micro dose flare protocols for poor-responding patients

Davar

Rahsepar

Rahmani

2012

Arch Gynecol Obstet

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Purpose This study aims to verify if luteal estradiol pretreatment improves IVF/ICSI outcomes in a GnRH antagonist protocol as compared with a micro dose GnRH agonist protocol in poor-responding patients. Methods A total of 116 IVF/ICSI cycles were included in this prospective randomized single blind clinical trial. The selected women were randomly assigned to receive an estradiol pre-treatment in a GnRH antagonist protocol (daily oral Estradiol Valerate 4 mg preceding the IVF cycle from the 21st day until the first day of the next cycle) or in oral contraceptive pill micro dose GnRH agonist protocol. Results The patients in the luteal estradiol protocol required more days of stimulation (10.9 ± 1.6 vs. 10.2 ± 1.8) and a greater gonadotropin requirement (3,247.8 ± 634.6 vs. 2,994.8 ± 611 IU), yet similar numbers of oocytes were retrieved and fertilized. There was no significant difference between the two groups in terms of the implantation rates (9.8 vs. 7.9 %) and the clinical pregnancy rates per transfer (16.3 vs. 15.6 %). Conclusion This study demonstrates that the use of estradiol during a preceding luteal phase in a GnRH antagonist protocol can provide similar IVF outcomes when compared to a micro dose GnRH agonist protocol.

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Section: Discussionmentioning

confidence: 99%

A comparative study of luteal estradiol pre-treatment in GnRH antagonist protocols and in micro dose flare protocols for poor-responding patients

Davar

Rahsepar

Rahmani

2012

Arch Gynecol Obstet

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“…The low rate of implantation is the main issue of ARTcycles in poor responders [18]. Besides progesterone, estrogen and other steroid hormones are made by luteal body.…”

Section: Introductionmentioning

confidence: 99%

“…This produced this question for researchers whether adding E2 to P supplementation could improve implantation rate or not [19]. Furthermore, most of the previous studies which reached positive effects of luteal phase E2 administration were designed for patients with a good ovarian response [7,18,20]. This controlled randomized clinical trial is designed to …”

Section: Introductionmentioning

confidence: 99%

Estradiol supplementation during the luteal phase in poor responder patients undergoing in vitro fertilization: a randomized clinical trial

Aghahosseini

Aleyassin

Khodaverdi

et al. 2011

J Assist Reprod Genet

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Purpose This study was designed to evaluate the effects of adding Estradiol (E2) supplementation to progesterone (P) on improvement of pregnancy outcomes in poor responder patients who underwent in vitro fertilization (IVF).Methods In a prospective randomized clinical trial, 118 poor responder patients, older than 38 years without contraindications of estradiol consumption from Infertility clinic of a university hospital were randomly divided (by computerized software) into two groups. Control group (59 patients) received only P and intervention group (59 patients) received P and E2 (4 mg/d). Supplementation was done with 4 mg E2 in the luteal phase. Fertilization rate, implantation rate, biochemical and clinical pregnancy rates, abortion rate, ongoing pregnancy, multiple pregnancy and ectopic pregnancy rates were documented for those who completed the study protocol in each group (per protocol analysis) and compared between groups. Result Fifty five patients in control group and 53 patients in intervention group successfully completed the study protocol. Treatment outcomes were not significantly different between two groups. Conclusion For poor responder women who underwent IVF, addition of E2 to P supplementation could not significantly improve pregnancy outcomes.

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“…Luteal E2 pre-treatment in non-downregulation protocols helps to abolish corpus luteum rescue and synchronize follicular development during IVF and also used to lower the serum FSH to restore FSH receptors in granulose theca cells preparing for the new cycle. Improvement in stimulation and pregnancy outcomes has been reported in poor responders with luteal E2 pre-treatment in various non-downregulation protocols including those with no pituitary suppression and GnRH antagonist protocols [25][26][27]15]. Although, this study offers promising results in that a trend toward shorter duration, lower amount and cost of medication, the study was limited by a small patient population and a power analysis may be helpful to determine sample size that would be needed to add evidence to this observation.…”

Section: Discussionmentioning

confidence: 92%

Clomiphene Citrate plus Modified GnRH Antagonist Protocol for Women with Poor Ovarian Response Undergoing ICSI Treatment Cycles: Randomized Controlled Trial

Abdel-Mohsen¹

2013

Gynecol Obstet

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Objective: To compare Clomiphene Citrate (CC) and lower dose of Human chorionic Gonadotropins (HMG) plus Gonadotropins Releasing Hormone (GnRH) antagonist with conventional mid-luteal long agonist GnRH with higher dose of HMG in women with poor ovarian response, undergoing Intracytoplasmic Sperm Injection (ICSI). Poor ovarian response was defined as the development of less than 3 follicles ≥ 17 mm on HCG day in a previous midluteal GnRH agonist-IVF/ICSI cycle or women with age >35 years old.Method: Pilot non blind two arms parallel randomised controlled. Seventy women with a history of previous poor ovarian response undergoing controlled ovarian hyperstimulation (COH) for ICSI. Interventions: The control group (n=35) received a conventional mid-luteal long GnRH agonist treatment with daily injections of HP HMG, starting on day 2 of the cycle at a dose of 300 IU /day. In the study group (n=35), pre-treatment with luteal E2 supplementation was administrated followed by clomiphene citrate for 5 days, starting on day 2 of the cycle followed by daily injections of 225 IU HP HMG and GnRH antagonist from cycle day 6 onward. Results:There was no evidence of statistically significant difference between both groups regarding the clinical pregnancy rate per women randomized (5/35 (14%) versus 3/35 (9%); 95% CI: 0.39-8.09, p=0.43). The cost of ovarian stimulation per cycle worked out to be USD 208, 8 and 557.3 for CC ovarian stimulation group and conventional ovarian stimulation group respectively.Conclusion: CC and a lower dose of HMG plus GnRH antagonist preceded by mid-luteal E2 supplementation is as effective as the conventional ovarian stimulation in producing similar ICSI outcomes at lower cost in women with poor ovarian response.

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Use of a luteal estradiol patch and a gonadotropin-releasing hormone antagonist suppression protocol before gonadotropin stimulation for in vitro fertilization in poor responders

Cited by 103 publications

References 20 publications

A comparative study of luteal estradiol pre-treatment in GnRH antagonist protocols and in micro dose flare protocols for poor-responding patients

A comparative study of luteal estradiol pre-treatment in GnRH antagonist protocols and in micro dose flare protocols for poor-responding patients

Estradiol supplementation during the luteal phase in poor responder patients undergoing in vitro fertilization: a randomized clinical trial

Clomiphene Citrate plus Modified GnRH Antagonist Protocol for Women with Poor Ovarian Response Undergoing ICSI Treatment Cycles: Randomized Controlled Trial

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