Use of gonadotropin-releasing hormone antagonists to overcome the drawbacks of intrauterine insemination on weekends

Checa, Miguel Ángel; Prat, Maria; Robles, Ana; Carreras, Ramón

doi:10.1016/j.fertnstert.2005.08.040

Cited by 28 publications

(37 citation statements)

References 16 publications

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“…On compiling all the scores of individual parameters we computed a total biophysical profile score. It was seen in the present study that 66% women who were administered GnRH antagonist had a favorable score (11)(12)(13)(14)(15) whereas in the control group it was only in 18% cases. Thus, it was concluded that there was a statistically significant difference between the two groups in uterine score (P <0.001).…”

Section: Discussioncontrasting

confidence: 41%

“…11 However, Checa et al observed no significant difference was found in number of follicles on administration of GnRH antagonist. 12 The analysis of the results demonstrated that the score for all the individual parameters of 'uterine biophysical profile' were higher in group receiving GnRH antagonist. In the present study we studied various uterine parameters that affect the implantation and pregnancy rates and the changes observed in these parameters after administration of GnRH antagonist (cetrorelix).…”

Section: Discussionmentioning

confidence: 96%

“…This observation is further supported by a prospective randomized trial conducted in 2006 by Checa et al In their study they found that cetrorelix significantly results in a thicker endometrium with an endometrial thickness of 9.9 ± 1.88 mm as compared to 8.6 ± 0.5 mm in the control group (P value = 0.001). 12 The triple line appearance of the endometrium at the time of ovulation, because of luminal stromal density, has been described by authors as a prognostic factor for pregnancy in gonadotropin stimulated cycles. The present study showed a statistically significant difference between the endometrial pattern score between the two groups as all women who received cetrorelix had a welldefined distinct 5 line appearance (trilaminar pattern) whereas in the control group 20% women only had hazy trilaminar pattern or absolutely no layering.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Effect of GnRH antagonist on follicular development and uterine biophysical profile in controlled ovarian stimulation

Tiwary

Dhaliwal

Gainder

2015

Int J Reprod Contracept Obstet Gynecol

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Section: Discussioncontrasting

confidence: 41%

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Effect of GnRH antagonist on follicular development and uterine biophysical profile in controlled ovarian stimulation

Tiwary

Dhaliwal

Gainder

2015

Int J Reprod Contracept Obstet Gynecol

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“…(23,24) The use of GnRH antagonists has also been shown to be effective in manipulating follicular development, so that the insemination process can be suspended on weekends without an apparent decrease in pregnancy rates. (25,26) The present study was not without limitations. The number of women enrolled in the study small; nevertheless, other studies investigating the same subject have also enrolled small numbers of patients.…”

Section: Discussionmentioning

confidence: 85%

Effect of GnRH antagonists on clinical pregnancy rates in ovulation induction protocols with gonadotropins and intrauterine insemination

Dansuk¹,

Gönenç²,

Sudolmus³

et al. 2015

smedj

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INTRODUCTIONIntrauterine insemination (IUI) is widely used as an infertility treatment modality. The success of assisted reproductive technologies is dependent on appropriate patient selection and adequate development of oocytes. Compared to clomiphene citrate ovarian stimulation, gonadotropin ovarian stimulation with IUI results in higher pregnancy rates. Moreover, the combination of controlled ovarian hyperstimulation (COH) + IUI has been shown to increase the fecundity of the cycle as compared to IUI alone.(1,2) There are variations in the reported clinical pregnancy rates of COH + IUI cycles; these may be attributed to differences in the aetiology and duration of infertility, sperm preparation technique, the number of sperms injected, the number of inseminations per cycle, cycle monitoring, IUI timing and the ovarian stimulation protocol selected. (2)(3)(4)(5) Although low-dose protocols with recombinant folliclestimulating hormone (rFSH) are used during COH + IUI cycles, (6) multifollicular development may occur and result in a sudden increase in serum estradiol (E2) levels, which can result in a premature luteinising hormone (LH) peak (before follicular maturation) and revocation of the IUI.(7) Gonadotropin-releasing hormone (GnRH) analogues lead to the desensitisation of pituitary GnRH receptors and, via this phenomenon, block endogenous LH increase. The use of GnRH analogues has been reported to lower premature LH peak to approximately 2% and subsequently increase pregnancy rates.(8) For more than ten years, the use of gonadotropins with GnRH agonists has been the most frequently applied treatment protocol for reducing the incidence of premature LH peak.(9) However, this treatment protocol, which needs 2-3 weeks of desensitisation time, also increases the amount of gonadotropins used, the risk of ovarian hyperstimulation syndrome and the duration of treatment. During the desensitisation period, patients are also exposed to side effects such as hot flushes, headaches, vaginal dryness and bleeding. These drawbacks have resulted in the recent removal of IUI treatment protocols, including GnRH agonists. A Cochrane review on ovarian stimulation protocols for IUI advised against the use of GnRH agonists in COH with low-dose exogenous FSH (i.e. mild COH). (10) GnRH antagonists, which are produced through the exchange of amino acids of GnRH with other molecules at multiple points, bind to GnRH receptors with high affinity.(11) These antagonistic molecules prevent the release of endogenous gonadotropin and are currently being considered to replace GnRH agonists due to their positive pharmacokinetic and pharmacodynamic properties. The advantages of GnRH antagonists include absence of the first flare-up effect, reduced risk of oestrogen deficiency syndrome (since there is no need for long-term desensitisation), sufficient LH blockage in a short duration of time, dose-dependent effect

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“…This could also be an incidental finding related to difference in patient profiles. Study conducted by Checa et al [17] showed increased endometrial thickness in GnRH antagonist group as compared to the control group. Studies conducted by Lee et al [8], Graziano et al [16], Allegra et al [9] and Steward et al [14] did not show significant difference between endometrial thicknesses in the two groups.…”

Section: Mild Ovarian Hyperstimulation (Moh) Is Defined As the Adminimentioning

confidence: 91%

Evaluation of Role of GnRH Antagonist in Intrauterine Insemination (IUI) Cycles with Mild Ovarian Hyperstimulation (MOH): A Prospective Randomised Study

Wadhwa

Khanna

Gupta

et al. 2016

J Obstet Gynecol India

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Aims and Objective To evaluate the role of GnRH antagonist in prevention of premature LH surge and increasing pregnancy rates in IUI cycle with mild ovarian hyperstimulation (MOH). Study Design Prospective parallel, randomised controlled study. Material and Methods Couples diagnosed with unexplained, male factor subfertility and with one or both tubes patent were randomised to receive either a GnRH antagonist (study group) or no intervention (control group 123 women were treated with clomiphene citrate (D3-D7) followed by HMG. A GnRH antagonist was added when one or more follicles of 16 mm diameter or more were visualised in the study group. When at least one follicle reached a size of C18 mm, ovulation was induced by hCG injection. A single IUI was performed 36 h later. The primary outcome was premature LH surge and pregnancy rate. The secondary outcomes were the amount of gonadotropins used, duration of use of GnRH antagonist and incidence and severity of OHSS. Results A total of seventy patients attending the infertility clinic in the outpatient department of Obstetrics and Gynecology, of a tertiary care centre, were recruited in the study which was carried out from August 2011 to March 2013. The study group included 34 women and 36 in the control arm. The incidence of premature LH surge was significantly lower in the antagonist group as compared to the control group 2.9 vs. 13.9 %, with a p value of \0.001. The clinical pregnancy rates were similar in both the groups 8.8 vs. 11.1 %, p value being 1.000. The amount of gonadotropins used in GnRH antagonist group was lower than in control group but not statistically significant. Duration of GnRH antagonist was 1.85 ± 0.61 days in the study group. Conclusion The delayed administration of GnRH antagonists in MOH with IUI cycles when follicle size is C16 mm is beneficial in terms of preventing the occurrence of premature LH surge but with no improvement in pregnancy rates.

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Use of gonadotropin-releasing hormone antagonists to overcome the drawbacks of intrauterine insemination on weekends

Cited by 28 publications

References 16 publications

Effect of GnRH antagonist on follicular development and uterine biophysical profile in controlled ovarian stimulation

Effect of GnRH antagonist on follicular development and uterine biophysical profile in controlled ovarian stimulation

Effect of GnRH antagonists on clinical pregnancy rates in ovulation induction protocols with gonadotropins and intrauterine insemination

Evaluation of Role of GnRH Antagonist in Intrauterine Insemination (IUI) Cycles with Mild Ovarian Hyperstimulation (MOH): A Prospective Randomised Study

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