Gonadotropin-releasing Hormone Agonist Group Research Articles

Follicular oestradiol and VEGF after GnRH antagonists or GnRH agonists in women with PCOS

The aim of this study was to determine whether follicular oestradiol and vascular endothelial growth factor (VEGF) concentrations in women with polycystic ovarian syndrome (PCOS) differ according to the use of gonadotrophin-releasing hormone (GnRH) antagonists or GnRH agonists. Furthermore, the effect of follicular oestradiol and VEGF concentrations on oocyte and embryo quality was investigated. In this prospective clinical study, 20 women with PCOS undergoing intracytoplasmic sperm injection for male factor infertility were included using a GnRH antagonist or a GnRH agonist protocol. In each follicle, oestradiol and VEGF concentrations were determined. In the GnRH antagonist group 254 follicles and in the GnRH agonist group 245 follicles, were aspirated. Fewer metaphase II (MII) and more immature and degenerative oocytes were registered in the GnRH antagonist group. Follicular oestradiol and VEGF were lower in the GnRH antagonist group ( P = 0.014 and P < 0.001, respectively). Moreover, higher oestradiol concentrations were related to embryos of higher quality ( P = 0.037). It is concluded that GnRH antagonists decrease follicular oestradiol and VEGF concentrations and the number of retrieved MII oocytes in women with PCOS.

Follitropin-α (Gonal-F) versus follitropin-β (Puregon) in controlled ovarian hyperstimulation for in vitro fertilization: is there any difference?

In an attempt to examine and compare the effect of the two commercially available recombinant FSH on ovarian stimulation characteristics and IVF cycle outcome, we studied 264 IVF cycles in patients with a favorable prognosis a priori, 198 in patients using follitropin-alpha, and 68 in patients using follitropin-beta. Although both groups achieved a comparable number of retrieved oocytes, the use of follitropin-beta was associated with a tendency toward a lower clinical pregnancy rate (PR), and with significantly higher E(2) levels despite the use of significantly lower total gonadotropin dose.

GnRH agonist therapy as ovarian protectants in female patients undergoing chemotherapy: a review of the clinical data

Cancer survival rates in young women are improving due to progress in treatment. This includes aggressive chemotherapy, a treatment that often poses a threat to fertility. GnRH agonists were proposed as ovarian protectors during gonadotoxic therapies. This study was undertaken in order to determine the clinical evidence concerning this issue. The medical literature was searched for studies that reported on ovarian function after the administration of GnRH agonists concomitant with chemotherapy. Twelve studies met the predetermined selection criteria. Data on ovarian function were obtained for 579 women who received chemotherapy. Among 345 women who received GnRH agonist co-treatment, ovarian function was preserved in 91% and 9% had premature ovarian failure. In 234 women who did not receive GnRH agonist co-treatment, ovarian function was preserved in 41% and failed in 59%. Only two of the studies were randomized. The control and the GnRH agonist groups differed in several important characteristics: the follow-up times were not equal, different treatment protocols were utilized and end-points were poorly defined and inconsistent between the studies. The effectiveness of GnRH agonists as fertility-preserving agents is debatable. A thorough literature search has found insufficient evidence to show that GnRH agonist co-treatment is effective in protecting the ovary from the damage of chemotherapy. A large randomized controlled trial with adequate follow-up is needed.

GnRH agonist versus GnRH antagonist in controlled ovarian hyperstimulation: their role in patients with an unfavorable prognosis a priori

In an attempt to examine the influence of the type of GnRH analogue used during controlled ovarian hyperstimulation on IVF outcome in patients with an unfavorable outcome a priori, we studied 728 consecutive cycles in patients with repeated IVF failure. In patients with repeated failure, the GnRH agonist group showed significantly higher clinical pregnancy rate compared with the GnRH antagonist group (20.8% vs 14.5%).

Comparison of embryological and clinical outcome in GnRH antagonist vs. GnRH agonist protocols for in vitro fertilization in PCOS non-obese patients. A prospective randomized study

Embryological and clinical efficacy of gonadotropin-releasing hormone (GnRH) antagonist and agonist stimulation protocols in non-obese women with polycystic ovarian syndrome (PCOS) were compared. A prospective randomized study. Medical University Hospital. 70 infertile PCOS patients; 33 in GnRH antagonist and 37 in GnRH agonist group. Similar mature metaphase II oocyte rate (76% vs. 76%) was observed in both protocols. Optimal pronuclear morphology zygotes dominated in both groups (64% vs. 66%). Transferred embryo quality did not differ in both protocols. No significant differences between both protocols were found in delivery rate (p = 0.481), pregnancy rate (p = 0.810), multiple pregnancy rate (p = 0.501), miscarriage rate (p = 0.154), fertilization rate (p = 0.388) and implantation rate (p = 1.000). Duration of stimulation and total follicle-stimulating hormone (FSH) dose were significantly lower in GnRH antagonist protocol (p = 0.0005). GnRH antagonist and agonist protocols in non-obese PCOS patients yield similar embryological and clinical outcomes. Shorter duration of treatment and lower FSH requirement in GnRH antagonist group may be financially beneficial and therefore attractive for patients.

Uterine Ultrasonographic Changes During Endometriosis Treatment: A Comparison Between Levonorgestrel-Releasing Intrauterine Devices and a Gonadotropin-Releasing Hormone Agonist

We compared the effects of levonorgestrel-releasing intrauterine devices (LNG-IUD) and a gonadotropin-releasing hormone agonist (GnRHa) on uterine volume, uterine arteries pulsatility index (PI) and endometrial thickness before and after six months of endometriosis treatment. Sixty women aged 18–40 y were allocated randomly to one of two groups: LNG-IUDs were inserted in 30 women, and GnRHa monthly injections were performed on the other 30. All 60 women were submitted to transvaginal 2-D ultrasound scans on the day that the treatment started and then six months later. Measurements of uterine arteries PI, uterine volume and endometrial thickness were performed at both evaluations. The use of LNG-IUDs significantly decreased endometrial thickness (pre = 6.08 ± 3.00 mm, post = 2.7 ± 0.98 mm; mean ± SD), as did the use of GnRHa (pre = 6.96 ± 3.82 mm, post = 3.23 ± 2.32 mm). The uterine volume decreased in the GnRHa group (pre = 86.67 ± 28.38 cm 3, post = 55.27 ± 25.52 cm 3), but not in the LNG-IUD group (pre = 75.77 ± 20.88 cm 3, post = 75.97 ± 26.62 cm 3). Uterine arteries PI increased for both groups; however, the increase was higher in the GnRHa group (0.99 ± 0.84 vs. 0.38 ± 0.84, p = 0.007; PI increase in GnRHa and in LNG-IUD groups, respectively). In conclusion, levonorgestrel released directly onto the endometrium by the LNG-IUD induced smaller uterine changes than did the hypoestrogenism induced by GnRHa. Nevertheless, both promoted similar effects on endometrial thickness. (E-mail: wpmartins@gmail.com)

No room for cancellation, coasting, or ovarian hyperstimulation syndrome in oocyte donation cycles

We retrospectively studied 429 IVF donor cycles in which ovulation was triggered with either hCG (175 cycles) or GnRH agonist (254 cycles). Of the donors in whom ovulation was triggered with hCG, 3.2% developed symptoms of moderate (2.2%) or severe (1%) ovarian hyperstimulation syndrome, while none of the IVF donor cycles that were triggered with the GnRH agonist presented ovarian hyperstimulation syndrome, needed coasting, or were cancelled.

Microdose gonadotropin-releasing hormone agonist flare-up protocol versus multiple dose gonadotropin-releasing hormone antagonist protocol in poor responders undergoing intracytoplasmic sperm injection–embryo transfer cycle

To compare the efficacy of microdose GnRH agonist (GnRH-a) flare-up and multiple dose GnRH antagonist protocols in patients who have a poor response to a long luteal GnRH-a protocol. Prospective, randomized, clinical study. University hospital. Forty-two poor responder patients undergoing intracytoplasmic sperm injection (ICSI)-embryo transfer cycle. Twenty-one patients received microdose leuprolide acetate (LA) (50 microg twice daily) starting on the second day of withdrawal bleeding. The other 21 patients received 0.25 mg of cetrorelix daily when the leading follicle reached 14 mm in diameter. Serum E(2) levels, number of growing follicles and mature oocytes, embryo quality, dose of gonadotropin used, cancellation, fertilization, implantation rate and pregnancy rate (PR). The mean serum E(2) concentration on the day of hCG administration was significantly higher in the microdose GnRH-a group than in the GnRH antagonist group (1,904 vs. 1,362 pg/mL). The clinical PRs per started cycle of microdose GnRH-a and GnRH antagonist groups were 14.2% and 9.5%, respectively. There were no statistically significant differences in the other ovulation induction characteristics, fertilization and implantation rates. Microdose GnRH-a flare-up protocol and multiple dose GnRH antagonist protocol seem to have similar efficacy in improving treatment outcomes of poor responder patients.

Triggering with human chorionic gonadotropin or a gonadotropin-releasing hormone agonist in gonadotropin-releasing hormone antagonist-treated oocyte donor cycles: findings of a large retrospective cohort study

To compare pregnancy rates and the incidence of ovarian hyperstimulation syndrome (OHSS) in donor stimulation cycles where final maturation of oocytes was induced with recombinant hCG or GnRH agonist. Retrospective, cohort study. Private infertility clinic. A total of 1171 egg donors performing 2077 stimulation cycles. Controlled ovarian hyperstimulation of egg donors with GnRH antagonist protocol triggered with recombinant hCG (rhCG; 250 microg) or GnRH agonist (triptorelin 0.2 mg) based on the physician's decision. Proportion of mature and fertilized oocytes per donor cycle; clinical, ongoing pregnancy and implantation rate in recipients; and incidence of moderate/severe OHSS in oocyte donors. The proportion of mature oocytes was comparable, whereas the difference in the fertilization rate reached statistical significance (65% vs. 69%). No significant differences were observed in the implantation rate or clinical and ongoing pregnancy rates per ET. The incidence of moderate/severe OHSS was 1.26% (13/1031; 95% confidence interval [CI], 0.74-2.15) and 0% (0/1046; 95% CI, 0.00-0.37) in the rhCG and GnRH agonist groups, respectively. Recipient outcome was not significantly different when using oocytes from GnRH antagonist-treated donor cycles triggered with hCG or GnRH agonist. However, GnRH agonist triggering was associated with a lower incidence of moderate/severe OHSS in egg donors.

Mitochondrial distribution and activity in human mature oocytes: gonadotropin-releasing hormone agonist versus antagonist for pituitary down-regulation

To analyze the effects of GnRH agonists versus antagonists on mitochondrial distribution and activity in human mature oocytes. Randomized research experimental study. Academic basic research laboratory and hospital-based fertility center. Two hundred twenty-five supernumerary mature oocytes from 44 patients. Fluorescent staining and confocal laser scanning microscopy on oocytes after the use of either GnRH agonist (group A) or GnRH antagonist (group B). Oocyte mitochondrial distribution pattern and activity using MitoTracker Orange CMTM Ros. More oocytes showing polarized mitochondrial distribution pattern were found in group A than in group B (35% vs. 14%). In group B, hCG rather than GnRH agonist, for ovulation induction, resulted in more oocytes showing heterogeneous (57% vs. 14%), in particular polarized (24% vs. 0) mitochondrial distribution. In groups A and B, fluorescence intensity did not vary according to mitochondrial distribution pattern. However, fluorescence intensity was higher in oocytes with polarized and large granules configurations in group B compared to group A. The GnRH agonist and antagonist may have different effects on oocyte mitochondrial distribution pattern and activity. The GnRH antagonist may induce mitochondrial hyperactivity, which may be detrimental to the oocyte.

Comparison of GnRH agonists and antagonists in normoresponder IVF/ICSI in Turkish female patients

To evaluate the results of gonadotropin-releasing hormone agonist (GnRHa) and gonadotropin-releasing hormone antagonist (GnRHant) use in two demographically matched groups of normoresponder in-vitro fertilisation or intracytoplasmic sperm injection (IVF/ICSI) patients in a prospective study. We randomised 93 patients undergoing IVF/ICSI between May 2005 and August 2006. Patients with IVF indications were included except for those with polycystic ovary syndrome or azoospermia, women older than 38 years and those with follicle-stimulating hormone (FSH) > or =10 IU/ml. Patients were stimulated with standard 225 IU recombinant FSH. In Group I (n=45) a daily dose of GnRHant cetrorelix acetate 0.25 mg was administered when follicles reached a diameter of > or =14 mm. Group II (n=48) patients were desensitised with the GnRHa, leuprolide acetate, in a long protocol. Human chorionic gonadotropin (hCG) was administered when at least three follicles of 18 mm in diameter were observed. Oocyte retrieval was scheduled 36 hours following hCG administration and embryos were transferred on day 3 after oocyte retrieval. The two groups were homogenous for age, infertility duration, basal FSH and serum oestradiol (E2) (P=0.537, P=0.911, P=0.103 and P=0.733, respectively). In Group II (the GnRHa group) more antral follicles (P<0.001), a longer induction duration (P=0.017) and higher peak E2 levels (P<0.001) were observed. No differences were observed in the number of oocytes retrieved (P=0.749), embryos achieved and transferred (P=0.677), or fertilisation rates (P=0.839) between the two groups. There was no statistically significant difference between groups in clinical pregnancy rates, cycle cancellation and ovarian hyperstimulation (P=0.437, P=0.109 and P=0.415, respectively). GnRHant and GnRHa provide comparable results in normoresponder patients, while GnRHant allows a greater flexibility in their treatment.

GnRH agonist protocol administration in the luteal phase in ICSI-ET cycles stimulated with the long GnRH agonistprotocol: a randomized, controlled double blind study

GnRH agonist administration in the luteal phase was reported to beneficially affect the clinical outcome of intracytoplasmic sperm injection (ICSI) and embryo transfer (ET) cycles. This double blind, randomized, placebo controlled trial evaluates whether a single dose GnRH agonist administered 6 days after ICSI increases ongoing pregnancy rates following ET in cycles stimulated with the long GnRH agonist protocol. Five hundred and seventy women undergoing ET following controlled ovarian stimulation with a long GnRH agonist protocol were included. In addition to routine luteal phase support with progesterone, women were randomized to receive a single 0.1 mg dose of triptorelin or placebo 6 days after ICSI. Randomization was done on the day of ET according to a computer generated randomization table. Ongoing pregnancy rate beyond 20th week of gestation was the primary outcome measure. The trial was powered to detect a 12% absolute increase from an assumed 38% ongoing pregnancy rate in the placebo group, with an alpha error level of 0.05 and a beta error level of 0.2. There were 89 (31.2%) ongoing pregnancies in the GnRH agonist group, and 84 (29.5%) in the control group (absolute difference +1.7%, 95% confidence interval -5.8% to +9.2%). Implantation, clinical pregnancy and multiple pregnancy rates were likewise similar in the GnRH agonist and placebo groups. Single 0.1 mg triptorelin administration 6 days after ICSI following ovarian stimulation with the long GnRH agonist protocol does not seem to result in an increase >or=12% in ongoing pregnancy rates.

GnRH agonist versus GnRH antagonist in ovarian stimulation: the role of endometrial receptivity

To examine whether the choice of the GnRH analogues used during controlled ovarian hyperstimulation (COH), may influence endometrial receptivity, we studied 712 IVF cycles, in patients undergoing COH with GnRH agonist or antagonist and with the transfer of at least one top-quality embryo. The GnRH agonist group showed significantly higher endometrial thickness and higher pregnancy rate, suggestive of a higher endometrial receptivity, compared with the GnRH antagonist group.

Comparison of Clinical Efficacy between a Single Administration of Long-Acting Gonadotrophin-Releasing Hormone Agonist (GnRHa) and Daily Administrations of Short-Acting GnRHa in In Vitro Fertilization-Embryo Transfer Cycles

This study was aimed to evaluate the efficacy of a single administration of long-acting gonadotrophin-releasing hormone agonist (GnRHa) as compared with daily administrations of short-acting GnRHa in controlled ovarian hyperstimulation (COH) for in vitro fertilization and embryo transfer (IVF-ET) cycles. The mean dosage of recombinant follicle-stimulating hormone (rFSH) required for COH (2,354.5±244.2 vs. 2,012.5±626.1 IU) and the rFSH dosage per retrieved oocyte (336.7±230.4 vs. 292.1±540.4 IU) were significantly higher in the long-acting GnRHa group (N=22) than those in the short-acting GnRHa group (N=28) (p<0.05). However, the mean number of visit to the hospital that was required before ovum pick-up (3.3±0.5 vs. 22.2±2.0) and the frequency of injecting GnRHa and rFSH (12.8±1.2 vs. 33.5±3.5) were significantly decreased in the long-acting GnRHa group (p<0.0001). The clinical pregnancy rate, implantation rate, and early pregnancy loss rate were not significantly different between the 2 groups. So, we suggest that a single administration of long-acting GnRHa is a useful alternative for improving patient's convenience with clinical outcomes comparable to daily administrations of short-acting GnRHa in COH for IVF-ET cycles.

Gene expression profile in human cumulus cells stimulated with purified FSH (hMG) or recombinant FSH (recFSH) combined with gonadotropin-releasing hormone agonist (GnRH-a) or antagonist (GnRH-ant)

In order to evaluate the impact of controlled ovarian stimulation (COS) protocols on cumulus cells, we studied their messenger RNA (mRNA) expression profile variations in patients undergoing long (GnRH-a) and short (GnRH-ant) controlled ovarian stimulation (COS) protocols using hMG or recFSH. The mRNA expression profiles of cumulus cells from individual patients were evaluated on DNA microarray chips. Gene expression levels and differential intensities between the groups were analyzed with bioinformatics tools. Cumulus cells of patients (n = 18) referred for an intracytoplasmic sperm injection (ICSI), stimulated with hMG or recFSH in a short GnRH-ant or long GnRH-a protocol, were mechanically removed on the day of egg collection for mRNA extraction. Pools of cumulus cells from a single patient were analyzed on Affymetrix™ HG-U133 plus 2.0 GeneChip microarrays. The Affymetrix™ GeneChip Operating Software 1.2 (GCOS) was used to evaluate the signal intensity for the 30000 unique human known or predicted genes. Sample groups were compared with the Significance Analysis of Microarrays (SAM) software to identify genes displaying restricted expression profiles. Principal component analysis on the genes with the highest average deviation across all samples revealed important variations between all patients, including those of a same COS group. When comparing hMG vs. recFSH, across all samples or within the long GnRH-a and short GnRH-ant groups, only trends in gene expression variation were observed. Yet, genes were found to be strictly restricted to hMG or recFSH COS protocols. Differential expression was more important for the GnRH-a vs. GnRH-ant comparison: under hMG stimulation, 52 genes are up-regulated (fold change >3, False Discovery Rate 0%) with the short GnRH-ant protocol whereas none is up-regulated by the long protocol. Similar results but with different genes were found for the same comparison between the recFSH groups. Exclusive genes were also found in the long GnRH-a and short GnRH-ant groups. Despite important patient to patient variations, we identified human genes differentially expressed when comparing hMG vs. recFSH or GnRH-a vs. GnRH-ant protocols. This will further the identification and understanding of the gene markers induced by the COS that are pertinent for the IVF outcome, thus permitting to better monitor the COS protocols for each patient and to improve the IVF practice.

The effects of GnRH antagonist vs. GnRH agonist down regulation on the outcome of IUI cycles

ObjectiveIt has been shown that up to 24% of non-down-regulated COH/IUI cycles may suffer premature luteinization. The use of down-regulation in controlled ovarian hyperstimulation (COH)/IUI cycles has improved pregnancy rates as compared to non-down-regulated cycles. The aim of this study is to compare the efficacy of GnRH antagonist to GnRH agonist down-regulation in COH/IUI cycles.DesignHistorical cohort study.Materials and methodsTable 1Comparison of GnRH agonist cycles to GnRH antagonist cycles outcomeGnRH agonist (n − 1258)GnRH antagonist (n − 626)Total (n = 1884)PPregnancy353 (28.1%)199 (31.9%)552 (29.3%)NSDelivery276 (21.9%)163 (26.0%)439 (23.3%)NSMiscarried63 (17.8%)26 (13.1%)89 (16.1%)NSEctopic14 (4.05)10 (5.0%)24 (4.3%)NS Open table in a new tab ResultsThe mean age for all the women was 32 ± 4.5 years. There was no significant difference in the mean age between the two groups. However, the mean duration of infertility was significantly longer (P=0.01) and the proportion of primary infertility was significantly greater (P=0.02) in the GnRH antagonist group. The mean number of follicles ≥16 mm (4.9 ± 3.0 compared to 4.2 ± 2.6) and the mean peak estradiol (E2) (1480 ± 850 pg/ml compared to 1210 ± 810 pg/ml)were significantly greater in the GnRH agonist group compared to the GnRH antagonist group (P=0.001 and P=0.01 respectively). After multiple logistic regression analyses, the type of infertility and the number of 16 mm follicles remained significant factors. The pregnancy rates in the 2 groups were similar (31.9% and 28.1% for group 1 and group 2 respectively). The delivery, miscarriage and ectopic pregnancy rates were similar in the 2 groups (Table 1).ConclusionsBoth GnRH Antagonist and GnRH agonist appear to have similar effectiveness during COH/IUI cycles. ObjectiveIt has been shown that up to 24% of non-down-regulated COH/IUI cycles may suffer premature luteinization. The use of down-regulation in controlled ovarian hyperstimulation (COH)/IUI cycles has improved pregnancy rates as compared to non-down-regulated cycles. The aim of this study is to compare the efficacy of GnRH antagonist to GnRH agonist down-regulation in COH/IUI cycles. It has been shown that up to 24% of non-down-regulated COH/IUI cycles may suffer premature luteinization. The use of down-regulation in controlled ovarian hyperstimulation (COH)/IUI cycles has improved pregnancy rates as compared to non-down-regulated cycles. The aim of this study is to compare the efficacy of GnRH antagonist to GnRH agonist down-regulation in COH/IUI cycles. DesignHistorical cohort study. Historical cohort study. Materials and methodsTable 1Comparison of GnRH agonist cycles to GnRH antagonist cycles outcomeGnRH agonist (n − 1258)GnRH antagonist (n − 626)Total (n = 1884)PPregnancy353 (28.1%)199 (31.9%)552 (29.3%)NSDelivery276 (21.9%)163 (26.0%)439 (23.3%)NSMiscarried63 (17.8%)26 (13.1%)89 (16.1%)NSEctopic14 (4.05)10 (5.0%)24 (4.3%)NS Open table in a new tab ResultsThe mean age for all the women was 32 ± 4.5 years. There was no significant difference in the mean age between the two groups. However, the mean duration of infertility was significantly longer (P=0.01) and the proportion of primary infertility was significantly greater (P=0.02) in the GnRH antagonist group. The mean number of follicles ≥16 mm (4.9 ± 3.0 compared to 4.2 ± 2.6) and the mean peak estradiol (E2) (1480 ± 850 pg/ml compared to 1210 ± 810 pg/ml)were significantly greater in the GnRH agonist group compared to the GnRH antagonist group (P=0.001 and P=0.01 respectively). After multiple logistic regression analyses, the type of infertility and the number of 16 mm follicles remained significant factors. The pregnancy rates in the 2 groups were similar (31.9% and 28.1% for group 1 and group 2 respectively). The delivery, miscarriage and ectopic pregnancy rates were similar in the 2 groups (Table 1). The mean age for all the women was 32 ± 4.5 years. There was no significant difference in the mean age between the two groups. However, the mean duration of infertility was significantly longer (P=0.01) and the proportion of primary infertility was significantly greater (P=0.02) in the GnRH antagonist group. The mean number of follicles ≥16 mm (4.9 ± 3.0 compared to 4.2 ± 2.6) and the mean peak estradiol (E2) (1480 ± 850 pg/ml compared to 1210 ± 810 pg/ml)were significantly greater in the GnRH agonist group compared to the GnRH antagonist group (P=0.001 and P=0.01 respectively). After multiple logistic regression analyses, the type of infertility and the number of 16 mm follicles remained significant factors. The pregnancy rates in the 2 groups were similar (31.9% and 28.1% for group 1 and group 2 respectively). The delivery, miscarriage and ectopic pregnancy rates were similar in the 2 groups (Table 1). ConclusionsBoth GnRH Antagonist and GnRH agonist appear to have similar effectiveness during COH/IUI cycles. Both GnRH Antagonist and GnRH agonist appear to have similar effectiveness during COH/IUI cycles.

Early cleavage does not predict treatment outcome following the use of GnRH antagonists in women older than 35

To compare the early-cleavage rates and the implantation potential of embryos between the GnRH antagonist and agonist long stimulation protocols in women older than 35 years. Retrospective analysis. Academic medical center. Two hundred twenty patients older than 35 years old underwent IVF. Sixty-eight patients received GnRH antagonist protocol (GnRH antagonist group) and 152 patients received GnRH agonist long stimulation protocol (GnRH agonist group). Early-cleavage rate of zygotes, implantation rate, and pregnancy rate. Early-cleavage rate of zygotes was significantly lower in the GnRH antagonist group than agonist group (21.8% vs. 32.6%, P<.0001). In the GnRH antagonist group, the pregnancy rate was not significantly different between the early-cleavage and late-cleavage subgroups (40.0% vs. 47.4%). In the GnRH agonist group, the pregnancy rate was significantly higher in the early-cleavage subgroup than in the late-cleavage subgroup (61.0% vs. 29.8%, P<.0001). In women older than 35 years, the early-cleavage rate of zygotes is significantly lower in the GnRH antagonist group than the agonist group. Early-cleavage status of zygotes is not a reliable predictor for embryo implantation in patients receiving the GnRH antagonist protocol.

Cryopreserved blastocyst transfer: impact of gonadotropin-releasing hormone agonist versus antagonist in the previous oocyte retrieval cycles

To assess any detrimental effect of gonadotropin-releasing hormone (GnRH) antagonists on oocyte quality and embryo development by comparing the outcome of cryopreserved-thawed blastocyst transfers for cycles using a GnRH agonist or GnRH antagonist protocol for the controlled ovarian stimulation in the oocyte retrieval cycle. Retrospective comparative study. Private IVF center. Seventy-seven women who underwent cryopreserved-thawed blastocyst transfer. The patients were divided into two groups based on whether they had been treated using a GnRH agonist long protocol (n = 44) or a GnRH antagonist multiple-dose protocol (n = 33) during the previous oocyte retrieval cycle. Cryopreserved-thawed blastocysts were transferred after endometrial preparation without pituitary suppression using a GnRH agonist. Implantation and clinical pregnancy rates. The postthaw survival rate and numbers of good quality blastocysts transferred were similar for the GnRH agonist and GnRH antagonist groups. Implantation and pregnancy rates for cryopreserved-thawed blastocyst transfer for the GnRH agonist group versus the GnRH antagonist group were 21.0% (25 of 119) versus 29.0% (27 of 93) and 38.6% (17 of 44) versus 51.5% (17 of 33), respectively, which was not statistically significantly different. No difference was found in terms of implantation and pregnancy rates when a GnRH agonist or GnRH antagonist was used in the previous oocyte retrieval cycle. Our results suggest that GnRH antagonists do not have a detrimental effect on oocyte quality or embryo development.

Expression of Estrogen and Progesterone Receptors in Smooth Muscle Metaplasia of Rectovaginal Endometriosis

To investigate expression of estrogen receptors (ER) and progesterone receptors (PR) in smooth muscle metaplasia (SMM) outside the endometriotic foci of rectovaginal endometriosis (RVE). One hundred and ninety-five specimens were obtained from the rectovaginal areas of the 63 patients who were underwent laparoscopic surgery for RVE. The patients were divided into 3 groups: a gonadotropin-releasing hormone (GnRH) agonist group, a non-GnRH group, including a proliferative phase group, and a secretory phase group. Expression of ER and PR in the rectovaginal tissues of RVE were determined using immunohistochemical methods. Smooth muscle metaplasia occurred in 172 specimens (88.2%), and ER and PR expression were found in the smooth muscle cells in the SMM areas outside the endometriotic foci of RVE. The expression of ER and PR in the GnRH agonist group were significantly lower than those in the non-GnRH agonist group. This is the first report demonstrating ER and PR in the smooth muscle cells in SMM outside the endometriotic foci of RVE. The ER and PR were expressed in the SMM areas, but these receptors were not recognized in fibrotic areas. We could identify the expression ratio of these receptors during each menstrual phase, with or without administered GnRH agonist.

High-dose atorvastatin causes regression of endometriotic implants: a rat model

This prospective randomized-controlled animal study was designed to determine the effects of atorvastatin on experimentally induced endometriosis in a rat model. Thirty-seven Wistar-Albino rats in which endometriotic implants were induced were randomly divided into four groups. Group I (Low-dose atorvastatin group, eight rats) were given 0.5 mg kg(-1) day(-1) oral atorvastatin. Group II (High-dose atorvastatin group, 10 rats) were given 2.5 mg kg(-1) day(-1) oral atorvastatin. Group III were given a single dose of 1 mg kg(-1) s.c. leuprolide acetate (GnRH agonist group, nine rats). Group IV were given no medication and served as controls (10 rats). All rats received the treatment for 21 days and were then euthanized to assess the implants' size, vascular endothelial growth factor (VEGF) level in peritoneal fluid and histological score. At the end of the treatment, the mean areas of implants were smaller and VEGF levels in peritoneal fluid were lower in Groups II and III than those in Group I and the control group (all P < 0.05). The mean areas of implants decreased from 41.2 +/- 13.9 to 22.7 +/- 13.9 mm(2) after medication in Group II and decreased from 41.2 +/- 18.1 to 13.1 +/- 13.8 mm(2) in Group III (both P < 0.05), whereas in Group I, the mean area increased from 43.0 +/- 12.7 to 50.5 +/- 13.9 mm(2) (P < 0.05). High-dose atorvastatin caused a significant regression of endometriotic implants.