Abstract
The aim of the present retrospective study was to investigate the effectiveness of single-dose gonadotropin releasing hormone (GnRH) antagonist administration, the day after human chorionic gonadotropin (hCG) triggering for final oocyte maturation, on the prevention of premature luteinization in patients with diminished ovarian reserve in in-vitro fertilization (IVF) cycles. The secondary objective of the study was to search the effect of this protocol on pregnancy outcomes. This is a retrospective study including 267 infertile patients who have single antral follicle seen with ultrasonography on the 2nd or 3rd day of the menstrual cycle before starting IVF treatment. We randomized patients into two groups. The case group comprised patients who had single-dose GnRH antagonist injection the day after hCG triggering formed, and the patients who had the standard treatment regime formed the control group. In both groups, the oocytes were collected 36 hours after hCG injection. The premature ovulation rate was significantly low in the case group compared with the control group (6.86 versus 20.6% per scheduled cycle) (p = 0.022). Also, the oocyte retrieval rate (93.14 versus 67.87% per scheduled cycle) (p = 0.013), the oocyte maturity rate (79.42 versus 47.87%) (p = 0.041), the fertilization rate (65.68 versus 34.54%) (p = 0.018), and the embryo transfer rate per scheduled cycle (44.11 versus 18.78%) (p = 0.003) were higher in the GnRH antagonist group than in the control group. The administration of GnRH antagonist the day after hCG trigger in IVF treatments of patients with diminished ovarian reserve enabled a significant decrease in the rate of premature ovulation but had no effect on live birth rate.
Highlights
Decrease is detected in the ovarian reserve in a mean of 10% of women due to various reasons regardless of age
The premature ovulation rate was significantly low in the case group compared with the control group (6.86 versus 20.6% per scheduled cycle) (p 1⁄4 0.022)
Conclusão A administração de antagonista de Gonadotropin-releasing hormone (GnRH), no dia seguinte ao desencadeamento de human chorionic gonadotropin (hCG) em tratamentos de fertilização in vitro (FIV) de pacientes com reserva ovariana diminuída permitiu uma redução significativa na taxa de ovulação precoce, mas não teve efeito na taxa de nascidos vivos
Summary
Decrease is detected in the ovarian reserve in a mean of 10% of women due to various reasons regardless of age. Diminished ovarian reserve is determined in women with low antral follicle count and, with low response to ovarian stimulation and low fecundity compared with other women of their age despite having regular menstrual cycles.[1] The increase of premature luteinization in patients with diminished ovarian reserve ( with a single oocyte) causes either cycle cancellation or early ovulation in the oocyte pick-up (OPU) period.[2] Gonadotropin-releasing hormone (GnRH) antagonists have recently been administered to avoid premature luteinizing hormone (LH) increase, and luteinization in the controlled ovarian hyperstimulation (COH) performed in in vitro fertilization (IVF) treatments.[3] Gonadotropin releasing hormone (GnRH) antagonists, in comparison with the GnRH agonist protocols, decrease the LH fluctuations more safely and effectively, in a shorter period, with fewer injections, and with less adverse effects.[4] Flare-up effect doesn’t occur due to hypo estrogenic side effect, shorten the cycle period, decrease the amount of gonadotrophine dosage, immediate effect and directly binding to GnRH receptors in the pituitary gland were the most significant advantage of GnRH antagonist protocol. The suppression ofLH secretion happens in a short period of time.[4,5] these advantages are important for patients with normal ovarian reserve, they are more important in patients with diminished ovarian reserve.[6]
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