GnRH agonist protocol versus GnRH antagonist protocol in assisted reproduction (original) (raw)
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Acta Obstetricia et Gynecologica Scandinavica, 2011
Objective. Endometriosis-associated infertility results in reduced ovarian response, fewer oocytes available for fertilization, compromised oocyte quality and higher miscarriage rates. A consistent proportion of women with endometriosis require in vitro fertilization. We sought to clarify the impact of deep infiltrating pelvic disease on antral follicle count and ovarian response to follicle-stimulating hormone (FSH) stimulation in patients with severe endometriosis. Design. Retrospective cohort study. Setting. University hospital. Population. Patients with severe endometriosis (stages III-IV; n=51) were divided into two groups regarding localization of endometriosis during surgical staging: ovarian (n=27) and both ovarian and deep infiltrating disease (n=24). Methods. A total of 73 long-protocol ovulation induction cycles with recombinant FSH for an intracytoplasmic sperm injection program were given. On day 3 of the cycle, measurements of FSH and luteinizing hormone and an ultrasound evaluation of antral follicle count were performed. Main Outcome Measures. Number of oocytes collected at ovum pick up, number of mature oocytes, number of embryos transferred and clinical pregnancy rate. Results. Ovarian reserve in terms of antral follicle count was damaged in both groups but, if adjusted for age, it was significantly lower in the ovarian and pelvic infiltrating group compared with patients having only ovarian endometriosis. Pelvic deep infiltrating disease significantly impacted on the number of oocytes collected at pick up when adjusted for age. Conclusions. Deep infiltrating pelvic disease can negatively affect ovarian reserve in terms of antral follicle count and number of oocytes retrieved. Mechanisms underlying this phenomenon need to be elucidated.
Human Reproduction, 2000
option that is increasingly offered to couples irrespective of Nuffield Department of Obstetrics and Gynaecology, University of the severity of disease present. However, it is unclear whether Oxford, Oxford Radcliffe Hospital, Women's Centre, Oxford, OX3 the presence of endometriosis adversely affects pregnancy and 9DU, UK live birth rates, and which mechanisms are responsible if 1 To whom correspondence should be addressed rates are lowered; it has been suggested that women with endometriosis have a lower ovarian response to gonadotro-In-vitro fertilization (IVF) is an effective infertility treatphins. Early reports suggested that women with endometriosis ment for women with endometriosis, but most women need undergoing ovarian stimulation in IVF-embryo transfer cycles to undergo several cycles of treatment to become pregnant.
Journal of Minimally Invasive Gynecology, 2009
We sought to compare the outcomes of in vitro fertilization (IVF) treatments in women with infertility-associated deep infiltrative endometriosis (DIE) who underwent extensive laparoscopic excision of endometriosis before IVF with those who underwent IVF only. Design: Prospective cohort study. Setting: Infertility clinic and private hospital in São Paulo, Brazil. Patients: A total of 179 infertile patients younger than 38 years had symptoms and/or signs of endometriosis and sonographic images suggestive of DIE. Interventions: After thorough counseling, 179 women were invited to participate in a prospective cohort study with 2 treatment options: IVF without undergoing laparoscopic surgery (group A, n 5 105) and extensive laparoscopic excision of DIE before IVF (group B, n 5 64). Ten women were lost to follow-up. The IVF outcomes were compared between the 2 groups. Measurements and Main Results: In group B, patients had 5 6 2 (mean 6 SD) DIE lesions excised during laparoscopy. Patient characteristics in groups A and B, respectively, were: age (32 6 3 vs 32 6 3 years, p 5 .94), infertility duration (29 6 20 vs 27 6 17 months, p 5 .45), day-3 serum follicle-stimulating hormone levels (5.6 6 2.5 vs 5.9 6 2.5 IU/L, p 5 .50), and previous IVF attempts (1 6 1 vs 2 6 1, p 5 .01). The IVF outcomes differed between groups A and B, respectively, with regard to total dose of recombinant follicle-stimulating hormone required to accomplish ovulation induction (2380 6 911 vs 2542 6 1012 IU, p 5 .01), number of oocytes retrieved (10 6 5 vs 9 6 5, p 5 .04), and pregnancy rates (24% vs 41%, p 5 .004), but not number of embryos transferred (3 6 1 vs 3 6 1, p 5 1). The odds ratio of achieving a pregnancy were 2.45 times greater in group B than in group A. Conclusion: Extensive laparoscopic excision of DIE significantly improved IVF pregnancy rates of women with infertilityassociated DIE.
JBRA assisted reproduction, 2017
Deep infiltrating endometriosis (DIE) can cause infertility and pelvic pain. There is little evidence of a clear connection between DIE and infertility, and the absolute benefits of surgery for DIE have not been established. This paper aimed to review the current literature on the effect of surgery for DIE on fertility, pregnancy, and IVF outcomes. Clinicians should bear in mind that a comprehensive clinical history is useful to identify patients at risk for endometriosis, although many women remain asymptomatic. Imaging can be useful to plan surgery. The effect of surgery on the fertility of women with DIE remains unanswered due to the heterogeneous nature of the disease and the lack of trials with enough statistical power and adequate follow-up. Surgery is not recommended when the main goal is to treat infertility or to improve IVF results. Decisions should be tailored according to the individual needs of each woman. Patients must be provided information on the potential benefits,...
Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics, 2016
Purpose To evaluate whether women with endometriosis have different ovarian reserves and reproductive outcomes when compared with women without this diagnosis undergoing in vitro fertilization/intracytoplasmic sperm injection (IVF/ ICSI), and to compare the reproductive outcomes between women with and without the diagnosis considering the ovarian reserve assessed by antral follicle count (AFC). Methods This retrospective cohort study evaluated all women who underwent IVF/ ICSI in a university hospital in Brazil between January 2011 and December 2012. All patients were followed up until a negative pregnancy test or until the end of the pregnancy. The primary outcomes assessed were number of retrieved oocytes and live birth. Women were divided into two groups according to the diagnosis of endometriosis, and each group was divided again into a group that had AFC 6 (poor ovarian reserve) and another that had AFC ! 7 (normal ovarian reserve). Continuous variables with normal distribution were compared using unpaired t-test, and those without normal distribution, using Mann-Whitney test. Binary data were compared using either Fisher's exact test or Chi-square (2) test. The significance level was set as p < 0.05. Results 787 women underwent IVF/ICSI (241 of which had endometriosis). Although the mean age has been similar between women with and without the diagnosis of endometriosis (33.8 AE 4 versus 33.7 AE 4.4 years, respectively), poor ovarian reserves were much more common in women with endometriosis (39.8 versus 22.7%). The chance of achieving live birth was similar between women with the diagnosis of endometriosis and those without it (19.1 versus 22.5%), and also when considering only women with a poor ovarian reserve (9.4 versus 8.9%) and only those with a normal ovarian reserve (25.5 versus 26.5%).
Gazzetta Medica Italiana Archivio per le Scienze Mediche, 2020
BacKGroUnd: the aim of this study was to evaluate the ivF/icSi outcome in endometriosis patient who received Gnrh analog as downregulation prior control ovarian stimulation (coh). MethodS: a retrospective study involving 86 women with endometriosis who had undergone ivF at our center between January 2015 till december 2017. the clinical pregnancy rate analyzed as the primary endpoint. other outcomes measured include the total dose gonadotropin, the duration of stimulation, the number of oocytes retrieved, the number of Mii oocytes, the number of grade 1 embryo, number of embryo transfer and frozen, fertilization and cancellation cycle rate. reSUltS: three groups were analyzed including stage ii (n.=26), stage iii (n.=27) and stage iv (n.=31). the clinical pregnancy rate higher in stage ii compares to stage iii and iv (69.2% vs. 37% vs. 38.7%). Surprisingly, they also had more follicles, oocytes retrieved and MII oocytes. The number of grade 1 embryo also significant seen in stage II compared to stage iii and iv with p-value 0.006 (3.15±2.3 vs. 2±1.49 vs. 1.63±1.40). Women with stage iii and iv endometriosis required a higher dose of endometriosis significantly (2781.94±835.57 and 2708.73±962.07) compared to stage ii (2052.40±620.79). the duration of stimulation is almost similar in all stages of endometriosis. there was a similar result seen in the number of embryos transferred. A more frozen embryo is seen in stage II endometriosis significantly. conclUSionS: Gnrh analogue integrated with coh protocol is recommended as a proper stimulation protocol for endometriosis especially in stage ii endometriosis.
Fertility and Sterility, 2020
To evaluate the effects of gonadotropin-releasing hormone agonists (GnRH-a) on fertility in women with mild endometriosis who are undergoing in vitro fertilization and embryo transfer (IVF-ET) procedures. Design: Prospective, randomized, controlled trial. Setting: Three tertiary university hospitals. Patient(s): Four hundred infertile women with mild endometriosis, documented with laparoscopy, undergoing IVF and 200 women with tubal factor infertility. Intervention(s): Administration of GnRH-a for 3 months before an IVF attempt (group A, n ¼ 200) or IVF without GnRH-a (group B, n ¼ 200). Main Outcome Measure(s): Follicular fluid (FF) levels of tumor necrosis factor a (TNF-a), interleukin-1b (IL-1b), IL-6, IL-8, and IL-1 receptor antagonist; fertilization rate (FR), implantation rate (IR), quality of embryos, and clinical pregnancy rate (PR). Result(s): Women who received GnRH-a had a statistically significantly reduced concentration of FF cytokines compared with women who did not receive this regimen. Women in group B had a reduced FR (61.7; 95% CI, 59.20-64.20) compared with the women in group A (72.7; 95% CI, 70.50-74.90) and compared with the women with tubal factor infertility (74.7; 95% CI, 72.00-77.24). The embryo quality, IR, and clinical PR showed no statistically significant improvement in the women of group A compared with group B. Conclusion(s): Women who received GnRH-a for 3 months had a lower concentration of FF cytokines. These women had also a higher FR than the women who did not receive GnRH-a. However, the IR, embryo quality, and clinical PR showed no statistically significant difference when comparing the two groups.
Human Reproduction, 2016
study question: Does a 3-month adjuvant hormonal treatment of mild peritoneal endometriosis after laparoscopic surgery influence the outcome of IVF stimulation in terms of number of mature oocytes obtained per cycle? summary answer: Complementary medical treatment of mild peritoneal endometriosis does not influence the number of oocytes per treatment cycle. what is known already: Endometriosis is a disease known to be related to infertility. However, the influence of superficial endometriosis-and its treatment-is still a matter of debate. study design, size, duration: A prospective controlled, randomized, open label trial was performed between February 2012 and March 2014 and embryological and clinical outcomes were measured. Patients with laparoscopically diagnosed peritoneal endometriosis (n ¼ 120) were treated by laser surgery after which they were sequentially randomized by computer-generated allocation to one of the two groups. The primary outcome of the trial was the number of Metaphase II (MII) oocytes. Sample size was chosen to detect a difference of two MII oocytes with a power of 80%. The control group (Group B) received the classical long protocol IVF stimulation, whereas the research group (Group A) had an additional pituitary suppression, of 3 months using a long-acting GnRH agonist, prior to IVF. participants/ materials, setting, methods: A total of 120 patients were included in the study, 61 of them in the study group and 59 patients in the control group. One patient of the control group was lost to follow up leading to 58 evaluable patients. main results and the role of chance: There was no difference in terms of the number of MII oocytes obtained per cycle: 8.2 in both groups (difference in MII between A and B: 0.07 [21.89; 2.04] 95% confidence interval (CI)). Pregnancy rate did not differ, being 39.3% for Group A (24 out of 61 patients) versus 39.7% for Group B (23 out of 58 patients) (95% CI around difference in pregnancy rate between A and B: 20.31% [217.96%; 17.86%]). However, a significantly (P ¼ 0.025) lower dose of FSH (2561 IU for Group A and 2303 IU for Group B, 95% CI around difference in FSH between B and A: 2258.6 IU [2483.4 IU; 233.8 IU]) and a significantly (P ¼ 0.004) shorter stimulation period (Group A 12.3 days and Group B 11.3 days, 95% CI around difference in stimulation period between B and A: 21.03 days [21.73 days; 20.33 days]) were needed to reach adequate follicle maturation in the control group. limitations, reason for caution: The validity of this study is limited to mild peritoneal endometriosis, and does not apply to ovarian endometriosis, which is also commonly seen in infertility patients. wider implications of the findings: There is no indication for complementary medical treatment of peritoneal endometriosis in terms of IVF outcome. On the contrary, stimulation takes longer and requires a higher amount of medication. study funding/competing interest(s): There was no external funding for this clinical trial in the IVF Center, AZ Jan Palfijn, Ghent. There are no competing interests to declare.
Gynecological Endocrinology, 2018
More empathized approach is required and is obligatory to women with premature ovarian insufficiency (POI) interested for pregnancy. In order to improve fertility rate in POI patients our suggestions would be: (1) To decrease FSH value to 10-15 IU/L by increasing estrogen. Oocyte donation can be suggested after a minimum of six month interval from FSH between 10-15 IU/L and when no dominant follicles are found. (2) To perform oral glucose tolerance test (OGTT). Insulin sensitizing agents has to be included, when indicated, 3-6 month before pregnancy. (3) TSH has to be 1-2.5 mM/L during 3-6 months before pregnancy. (4) Tests for thrombophyllia (Leiden V, FII, MTHFR, PAI) have to be obligatory. They are less expensive than those repeated in vitro fertilizations. Therapy has to be included according to the indications. (5) In order to regulate disturbed immune response in POI patients with endometriosis oral contraceptive therapy is needed for atleast six months prior to the pregnancy. (5) Encourage the patients and advice them about healthy life style and eating habits. (6) Add other drugs, when they are indicated. Complex interplay between endocrine, immunological, haematological, and psychological factors are very often underdetected in POI patients. It is very important to find out the real time for oocyte donation after correcting all the disturbances, improving endometrium receptivity and reaching women's acceptable psychological status. Untreated disturbances induce cardiovascular diseases, diabetes mellitus, thyroid diseases, coagulopathioes etc.
The objective of this study was to evaluate the histopathological characteristics of endometrial biopsies taken on the day of oocyte recovery in in-vitro fertilization (IVF) cycles with a satisfactory response to ovulation induction. A group of 33 patients who went through ovulation induction for IVF, and in whom an endometrial polyp was suspected on transvaginal ultrasonography during the monitoring phase, were studied. Following oocyte recovery, hysteroscopy, polypectomy and endometrial curettage were performed. Dating of endometrial glands and stroma was carried out in the tissue not containing the polyps. The total dose of follicle stimulating hormone (FSH), duration of ovulation induction, peak oestradiol and luteinizing hormone (LH) concentrations, thickness of endometrium and number of oocytes were recorded and compared to the endometrial dating of the specimens. In 15 cycles (45.5%), the endometrium was classified as 'in phase' (group I), 'advanced' by 2-4 days in a further 15 (45.5%, group II), and in the remaining three cycles (9%) it was delayed in maturation (group III). Younger age was correlated with advanced staging of the endometrium (r ⍧ -0.42; P ⍧ 0.015). Women with 'in phase' and 'advanced' maturation were similar in their response to ovulation induction; however, there was a strong correlation between advanced dating of endometrium and number of oocytes retrieved (r ⍧ 0.49; P ⍧ 0.04). Endometrial staging on the day of oocyte retrieval varied widely in patients treated by the same gonadotrophin-releasing hormone agonist (GnRHa)/FSH protocol for ovulation induction. This difference was not predictable by parameters monitored through the cycles.