PubMed Health⌕ Search
Home/Archive/PubMed

PubMed · 15643688

[Optimizing ovarian stimulation for IVF using GnRH antagonists].

E M Kolibianakis
View original source ↗Export metadata ↓

Abstract

ART teams have failed to predict that pregnancy rates in GnRH antagonist regimens will be lower compared to the agonist regimens. No evidence appears to exist for an adverse effect of GnRH antagonists on oocyte/embryo quality. Abnormal development of endometrium at OPU is present in all cycles stimulated with GnRH antagonists and it is also encountered in all stimulation schemes using gonadotropins. Endometrium advancement is negatively associated with the probability of pregnancy. Endometrium histology at oocyte retrieval is positively associated with LH levels at initiation of stimulation and the duration of rec FSH stimulation prior to antagonist initiation. The presence of elevated serum progesterone on day two of the cycle is associated with a higher exposure to progesterone and a decreased probability of pregnancy. The higher the LH levels on day 8 of stimulation, the lower the probability of pregnancy. Low E2 levels on the day of hCG administration are not associated with a decreased probability of pregnancy. Ovarian stimulation for IVF alters steroid receptor kinetics in the follicular phase. Prolongation of follicular phase is associated with a decreased probability of pregnancy. Prolongation of follicular phase results in secretory changes of endometrium at OPU.

Explore related subjects

AnovulationClinical ProtocolsDrug Administration ScheduleDrug MonitoringEndometriumEstradiolFemaleFertilization in VitroFollicular PhaseGonadotropin-Releasing HormoneHumansLuteinizing HormoneOvulation InductionPredictive Value of TestsPregnancyPregnancy RateTime FactorsEnglish AbstractJournal ArticleReview

Keep this discovery

Explore connections, maps & timelines

BibTeXRIS

E M Kolibianakis. 2004. [Optimizing ovarian stimulation for IVF using GnRH antagonists].. https://pubmed.ncbi.nlm.nih.gov/15643688/

Cite the original work for its findings. Save a collection to share your selection of sources.

KEEP EXPLORING

Related citations

PubMed2006

Does previous response to clomifene citrate influence the selection of gonadotropin dosage given in subsequent superovulation treatment cycles?

PURPOSE: To determine whether ovarian response to previous clomifene treatment could influence the selection of the starting dose of gonadotropins in subsequent in vitro fertilization (IVF) or intra uterine insemination (IUI). METHODS: Forty three anovular women who had received clomifene for ovulation induction followed by gonadotropins for IUI or IVF superovulation were reviewed retrospectively. Data on gonadotropin dose were compared between clomifene-resistant patients and clomifene responders. RESULTS: IVF patients who had had prior superovulation/IUI treatment received similar doses of gonadotropins regardless of response to clomifene (1610 IU versus 1560 IU, p = 0.74). In IVF patients not receiving prior IUI treatment, the clomifene-resistant women were given higher doses of gonadotropins than those responding to clomifene (2500 IU versus 1440 IU, p = 0.042). CONCLUSIONS: We found that, in our Unit, clinicians appeared to use prior non-response to clomifene as a reason for prescribing a higher starting dose of gonadotropins in IVF treatment, a practice that is not evidence-based.

Anovulation↗
PubMed2006

The use of a decremental dose regimen in patients treated with a chronic low-dose step-up protocol for WHO Group II anovulation: a prospective randomized multicentre study.

BACKGROUND: In women with chronic anovulation, the choice of the FSH starting dose and the modality of subsequent dose adjustments are critical in controlling the risk of overstimulation. The aim of this prospective randomized study was to assess the efficacy and safety of a decremental FSH dose regimen applied once the leading follicle was 10-13 mm in diameter in women treated for WHO Group II anovulation according to a chronic low-dose (CLD; 75 IU FSH for 14 days with 37.5 IU increment) step-up protocol. METHODS: Two hundred and nine subfertile women were treated with recombinant human FSH (r-hFSH) (Gonal-f) for ovulation induction according to a CLD step-up regimen. When the leading follicle reached a diameter of 10-13 mm, 158 participants were randomized by means of a computer-generated list to receive either the same FSH dose required to achieve the threshold for follicular development (CLD regimen) or half of this FSH dose [sequential (SQ) regimen]. HCG was administered only if not more than three follicles >or=16 mm in diameter were present and/or serum estradiol (E(2)) values were <1200 pg/ml. The primary outcome measure was the number of follicles >or=16 mm in size at the time of hCG administration. RESULTS: Clinical characteristics and ovarian parameters at the time of randomization were similar in the two groups. Both CLD and SQ protocols achieved similar follicular growth as regards the total number of follicles and medium-sized or mature follicles (>/=16 mm: 1.5 +/- 0.9 versus 1.4 +/- 0.7, respectively). Furthermore, serum E(2) levels were equivalent in the two groups at the time of hCG administration (441 +/- 360 versus 425 +/- 480 pg/ml for CLD and SQ protocols, respectively). The rate of mono-follicular development was identical as well as the percentage of patients who ovulated and achieved pregnancy. CONCLUSIONS: The results show that the CLD step-up regimen for FSH administration is efficacious and safe for promoting mono-follicular ovulation in women with WHO Group II anovulation. This study confirms that maintaining the same FSH starting dose for 14 days before increasing the dose in step-up regimen is critical to adequately control the risk of over-response. Strict application of CLD regimen should be recommended in women with WHO Group II anovulation.

Anovulation↗