Journal of Family and Reproductive Health 2015. 9(3):141-146.

Fixed versus Flexible Gonadotropin Releasing Hormone Antagonist Protocol in Controlled Ovarian Stimulation for Invitro Fertilization in Women with Polycystic Ovary Syndrome
Batool Hossein Rashidi, Tahereh Behrouzi Lak, Ensiyeh Shahrokh Tehrani, Fatemeh Davari Tanha

Abstract


Objective:This study was conducted to compare the results of fixed versus flexible GnRH antagonist protocols in controlled ovarian stimulation for Intra Cytoplasmic Sperm Injection (ICSI) in patients with PCOS.
Materials and methods:A randomized clinical trial was performed on 100 PCOS women, who were admitted to a tertiary infertility clinic and were candidate for IVF/ICSI. They were divided into two groups based on the GnRH antagonist protocol. We started GnRH antagonist 0.25mg in flexible protocol when a follicle ≥ 14 mm in diameter was seen in transvaginalsonography (Group 1). In fixed protocol, GnRH antagonist was administered from day 6 of stimulation (Group 2). Number of oocytes in methapase 2, number of developed and frozen embryo as main outcome and days of stimulation, number of gonadotropin and antagonist used assecondry outcome measures were assessed and compared between the two groups.
Results:The days of stimulation and the number of antagonist used was not significantly different between fixed and flexible group (p≥0.05).Although the number of gonadotropin injections was significantly lower in flexible group (p=0.03), the number of oocyte retrieved and the number of embryo which cryopreserved was significantly higher  in flexible compared to fixed  protocol (p<0.01).
Conclusion:It seems using flexible antagonist protocol in PCOS infertile patients is in favor of better outcomes in terms of number of good quality oocytes and embryo and possibility for cryopreservation for future cycles.


Keywords


GnRH Antagonist; Fixed Protocol; Flexible Protocol; PCOS; IVF/ICSI

Full Text:

PDF

References


Carmina E, Lobo RA. Polycystic ovary syndrome (PCOS): arguably the most common endocrinopathy is associated with significant morbidity in women. J ClinEndocrinolMetab1999 ;84:1897-9.

Siebert TI, Kruger TF, Grieve CL, Steyn DW. Is the use of a GnRH antagonist effective in patients with polycystic ovarian syndrome? A South African perspective. SAJOG 2012;18:11- 4.

The Rotterdam ESHRE/ASRM-sponsored PCOS consensus workshop group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod 2004;19: 41-7.

Lainas TG, Sfontouris IA, Zorzovilis IZ, Petsas GK, Lainas GT, Alexopoulou E, et al. Flexible GnRH antagonist protocol ersus GnRH agonist long protocol in patients with polycystic ovary syndrome treated for IVF: a prospective randomised controlled trial (RCT). Hum Reprod 2010; 25:683-9.

Al-Inany HG, Youssef MA, Aboulghar M, Broekmans F, Sterrenburg M, Smit J, et al. Gonadotropin-releasing hormone antagonists for assisted reproductive technology. Cochrane Database Syst Rev. 2011 May 11:CD001750.

Blumenfeld Z. Gonadotropin-releasing hormone antagonists instead of agonists: a change for the better? FertilSteril 2001;76: 443-4.

Borm G, Mannaerts B. Treatment with the gonadotrophin- releasing hormone antagonist ganirelix in women undergoing ovarian stimulation with recombinant follicle stimulating hormone is effective, safe and convenient: results of a controlled, randomized, multicentre trial. The European Orgalutran Study Group. Hum Reprod2000 ;15:1490-8. Erratum in: Hum Reprod 2000;15:1877.

European Middle East Orgalutran Study Group. Comparable clinical outcome using the GnRH antagonist ganirelix or a long protocol of the GnRH agonist triptorelin for the prevention of premature LH surges in women undergoing ovarian stimulation. Hum Reprod 2001;16 : 644–51.

Kolibianakis EM, Venetis CA, Kalogeropoulou L, Papanikolaou E, Tarlatzis BC. Fixed versus flexible gonadotropin-releasing hormone antagonist administration in in vitro fertilization: a randomized controlled trial. FertilSteril 2011;95:558-62.

Escudero E, Bosch E, Crespo J, Simón C, Remohí J, Pellicer A. Comparison of two different starting multiple dose gonadotropin-releasing hormone antagonist protocols in a selected group of in vitro fertilization-embryo transfer patients. FertilSteril 2004; 81:562-6.

11. Ashrafi M, Moini A, Mohammadzadeh A, Ezabadi Z, Zafarani F,Baghestani AR, et al. A comparative study of GnRH antagonist and GnRH agonist in PCO patients undergoing IVF/ICSI cycles. Iran J Reprod Med 2005; 3: 14–8.

Kolibianakis EM, Collins J, Tarlatzis BC, Devroey P, Diedrich K, Griesinger G. Among patients treated for IVF ith gonadotrophins and GnRH analogues, is theprobability of live birth dependent on the type of analogue used? A systematicreview and meta-analysis. Hum Reprod Update 2006;12: 651-71.

Al-Inany HG, Abou-Setta AM, Aboulghar M. Gonadotrophin-releasing hormone antagonists for assisted conception: a Cochrane review. Reprod Biomed Online 2007;14:640-9.

Lin H, Li Y, Li L, Wang W, Yang D, Zhang Q. Is a GnRH antagonist protocol better in PCOS patients? A meta-analysis of RCTs. PLoS One 2014;9: e91796.

Ludwig M, Katalinic A, Banz C, Schröder AK, Löning M, Weiss JM, et al. Tailoring the GnRH antagonist cetrorelix acetate to individual patients' needs in ovarian stimulation for IVF: results of a prospective, randomized study. Hum Reprod 2002;17:2842-5.

Mochtar MH; Dutch Ganirelix Study Group. The effect of an individualized GnRH antagonist protocol on folliculogenesis in IVF/ICSI. Hum Reprod 2004;19:1713-8.

Depalo R, Jayakrishan K, Garruti G, Totaro I, Panzarino M, Giorgino F, Et al. GnRH agonist versus GnRH antagonist in in vitro fertilization and embryo transfer (IVF/ET). ReprodBiolEndocrinol 2012;10:26.

Kolibianakis EM, Albano C, Camus M, Tournaye H, Van Steirteghem AC, Devroey P. Initiation of gonadotropin- eleasing hormone antagonist on day 1 as compared to day 6 of stimulation: effect on hormonal levels and follicular development in in vitro fertilization cycles. J Clin Endocrinol Metab 2003;88:5632-7.

Kolibianakis EM, Zikopoulos K, Smitz J, Camus M, Tournaye H, Van Steirteghem AC, et al. Administration of gonadotropin-releasing hormone antagonist from day 1 of stimulation in in vitro fertilization. FertilSteril 2004; 82:223-6.

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;13:628-38.

Hamdine O, Broekmans FJ, Eijkemans MJ, Lambalk CB, Fauser BC, Laven JS, Et al. Early initiation of gonadotropin- eleasing hormone antagonist treatment results in a more stable endocrine milieu during the mid- and late-follicular hases: a randomized controlled trial comparing gonadotropin-releasing hormone antagonist initiation on cycle day 2 or 6. Fertil Steril2013;100:867-74.


Refbacks

  • There are currently no refbacks.


Creative Commons Attribution-NonCommercial 3.0

This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License which allows users to read, copy, distribute and make derivative works for non-commercial purposes from the material, as long as the author of the original work is cited properly.