Journal of Reproduction & Infertility

Journal of Reproduction & Infertility

Effect of Pre-ovulatory Single Dose GnRH Agonist Therapy on IVF Outcome in GnRH Antagonist Cycles; A Prospective Study

Authors
Harpreet Kaur
Deepika Krishna
Nivedita Shetty
Sandhya Krishnan
M.S Srinivas
Kamini A. Rao
Consultant Reproductive Medicine, Bangalore Assisted Conception Centre, Bangalore, India
Abstract
Background: The purpose of present study was to evaluate the role of pre-ovulatory GnRH agonist therapy on IVF outcomes in GnRH antagonist cycles. Methods: In this prospective study we recruited 100 infertile women undergoing IVF cycles with GnRH antagonists. The patients were assigned to two groups: Group A (the study group, n=42) were assigned for receiving hCG+triptorelin for the final oocyte maturation and group B (the control group, n=58) were assigned for only hCG. The t-test, chi-square (2), and Fisher's exact test were used for data analysis. A p < 0.05 was taken as statistically significant. The results are presented by mean SD, and in percents (%). Results: LH levels significantly (p < 0.001) increased in the study group on the day of oocyte retrieval. All embryological parameters including the number of mature oocytes, fertilization and cleavage rates, number of high quality embryos and number of cases whose embryos were frozen were non-significantly higher in the study group. There were small but non-significant improvements in the clinical pregnancy, ongoing pregnancy, live birth and implantation rates in the study group. Conclusion: Administering a single dose of GnRH agonist before oocyte retrieval in antagonist cycles may be helpful in improving the pregnancy rate but the results need to be verified in a larger trials.
Keywords
Antagonist
GnRH
IVF
Ovulation
Pregnancy outcome
Trigger
Fleming R, Adam AH, Barlow DH, Black WP, Mac Naughton MC, Coutts JR. A new systematic treatment for infertile women with abnormal hormone profiles. Br J Obstet Gynaecol. 1982;89 (1):80-3.
Ludwig M. Text book of Assisted Reproductive Technologies. 3rd ed. London: Informa healthcare UK Ltd; 2009. P. 539.
Schachter M, Friedler S, Ron-El R, Zimmerman AL, Strassburger D, Bern O, et al. Can pregnancy rate be improved in gonadotropin-releasing hormone (Gn RH) antagonist cycles by administering GnRH agonist before oocyte retrieval? A prospective, randomized study. Fertil Steril. 2008;90(4):1087-93
Griesinger G, Diedrich K, Tarlatzis BC, Kolibianakis EM. GnRH-antagonists in ovarian stimulation for IVF in patients with poor response to gonadotrophins, polycystic ovary syndrome, and risk of ovarian hyperstimulation: a meta-analysis. Reprod Biomed Online. 2006;13(5):628-38.
Al-Inany HG, Abou-Setta AM, Aboulghar M. Go-nadotrophin-releasing hormone antagonists for assisted conception. Cochrane Database Syst Rev. 2006;(3):CD001750.
Kolibianakis EM, Collins J, Tarlatzis BC, Devroey P, Diedrich K, Griesinger G. Among patients treated for IVF with gonadotrophins and GnRH analogues, is the probability of live birth dependent on the type of analogue used? A systematic review and meta-analysis. Hum Reprod Update. 2006;12(6):651-71.
Zikopoulos K, Kolibianakis EM, Camus M, Tournaye H, Van den Abbeel E, Joris H, et al. Duration of gonadotropin-releasing hormone antagonist administration does not affect the outcome of subsequent frozen-thawed cycles. Fertil Steril. 2004;81 (2):473-5.
Kol S, Lightman A, Hillensjo T, Devroey P, Fauser B, Tarlatzis B, et al. High doses of gonadotrophin-releasing hormone antagonist in in-vitro fertilization cy-cles do not adversely affect the outcome of subsequent freeze-thaw cycles. Hum Reprod. 1999;14(9): 2242-4.
Yu B, Ruman J, Christman G. The role of peripheral gonadotropin-releasing hor-mone receptors in female reproduction. Fertil Steril. 2011;95(2):465-73.
Pirard C, Donnez J, Loumaye E. GnRH agonist as luteal phase support in assisted reproduction technique cycles: results of a pilot study. Hum Reprod. 2006;21(7):1894-900.
Tesarik J, Hazout A, Mendoza-Tesarik R, Mendoza N, Mendoza C. Beneficial ef-fect of luteal-phase GnRH agonist administration on embryo implantation after ICSI in both GnRH agonist- and antagonist-treated ovarian stimulation cycles. Hum Reprod. 2006;21(10):2572-9.
Lin YC, Chang SY, Lan KC, Huang HW, Chang CY, Tsai MY, et al. Human oocyte maturity in vivo determines the outcome of blastocyst development in vitro. J Assist Reprod Genet. 2003;20(12): 506-12.
Veek LL. An Atlas of human gametes and conceptuses. 1st ed. London. Parthenon; 1999. p. 215.
Youssef MA, Van der Veen F, Al-Inany HG, Griesinger G, Mochtar MH, van Wely M Gonadotropin-releasing hormone agonist versus HCG for oocyte triggering in antagonist assisted reproductive technology cycles. Cochrane Database Syst Rev. 2010;(11):CD008046.
Hernandez ER. Embryo implantation and GnRH antagonists: embryo implantation: the Rubicon for GnRH antagonists. Hum Reprod. 2000;15(6):1211-6
Raga F, Casañ EM, Kruessel J, Wen Y, Bonilla-Musoles F, Polan ML. The role of gonadotropin-releasing hormone in murine preimplantation embryonic development. Endocrinology. 1999;140(8): 3705-12.
Rackow BW, Kliman HJ, Taylor HS. GnRH antagonists may affect endometrial receptivity. Fertil Steril. 2008;89(5):1234-9.
Tesarik J, Hazout A, Mendoza C. Enhancement of embryo developmental potential by a single administration of GnRH agonist at the time of implantation. Hum Reprod. 2004;19(5):1176-80.
Isik AZ, Caglar GS, Sozen E, Akarsu C, Tuncay G, Ozbicer T, et al. Single-dose GnRH agonist administration in the luteal phase of GnRH antagonist cycles: a prospective randomized study. Reprod Biomed Online. 2009;19(4):472-7.
Ata B, Urman B. Single dose GnRH agonist administration in the luteal phase of assisted reproduction cycles: is the effect dependent on the type of GnRH analogue used for pituitary suppression? Reprod Biomed Online. 2010;20(1):165-6.
Journal of Reproduction & Infertility
Volume 13, Issue 4
Autumn 2012
Pages 225-231