Premature Luteinizing Hormone Surge Research Articles

Comparative study between agonist and antagonist protocols in PCOS patients undergoing ICSI: a cross-sectional study

BackgroundPolycystic ovary syndrome (PCOS) is one of the most common endocrinopathies affecting 5–10% of women of reproductive age. The syndrome is surrounded by controversies regarding both its diagnosis and treatment. The introduction of long-acting GnRH agonists in the late 1980s revolutionized the approach to ovarian stimulation in assisted reproductive technologies by providing the means to downregulate endogenous pituitary gonadotropin secretion and thereby prevent a premature luteinizing hormone surge during exogenous gonadotropin stimulation. The relatively recent introduction of GnRH antagonists in clinical practice has provided another option for ovarian stimulation in IVF. The purpose of this study was to compare the efficacy of the fixed GnRH antagonist vs. GnRH agonist long protocol in patients with polycystic ovary syndrome treated by ICSI.ResultsThere is a statistically significant difference between both groups in view of the received dose of gonadotrophin (1901.7 ± 400.6 vs. 1789 ± 368 with p = .004) and duration of stimulation (11.3 ± 0.8 vs. 10.3 ± 1.1 with p = .017). There is no significant difference between both groups in view of pregnancy outcome (37% vs. 32% with p = .125). There is a significant difference between both groups in view of ovarian hyperstimulation syndrome (OHSS) incidence where the rates were 15%, 6%, and 1.5% vs. 4.5%, 2.5%, and .05% with p = 0.04 for mild, moderate, and severe, respectively, form of OHSS in group 1 and group 2.ConclusionThe antagonist protocol may be the preferred stimulation protocol for PCOS patients treated by ICSI in view of the reduction of OHSS incidence rates without compromising the pregnancy outcome.

A novel GnRH antagonist protocol by switching antagonist to provera to prevent premature luteinizing hormone surge when patients turned out to be at high risk of ovarian hyperstimulation syndrome during ovarian stimulation

A novel GnRH antagonist protocol by switching antagonist to provera to prevent premature luteinizing hormone surge when patients turned out to be at high risk of ovarian hyperstimulation syndrome during ovarian stimulation

Prevention of premature luteinizing hormone surge in poor responders with twice-daily GnRH-antagonist administration

Prevention of premature luteinizing hormone surge in poor responders with twice-daily GnRH-antagonist administration

Evaluation of Ovarian Stimulation Initiated From the Late Follicular Phase Using Human Menopausal Gonadotropin Alone in Normal-Ovulatory Women for Treatment of Infertility: A Retrospective Cohort Study.

Objective: To investigate the feasibility of ovarian stimulation initiated in the late follicular phase using human menopausal gonadotropin (hMG) alone in ovulatory patients undergoing in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) treatments by comparison with that of the short gonadotropin-releasing hormone agonist (GnRH-a) protocol in terms of ovarian response, embryological characteristics, and pregnancy outcomes following frozen-thawed embryo transfer (FET) cycles.Design: Retrospective cohort study.Setting: A university-affiliated tertiary hospital.Patients: 135 infertile women undergoing their first IVF/ICSI treatment with the freeze-all strategy.Interventions: In the study group, ovarian stimulation was initiated in the late follicular phase using hMG alone, with the confirmation of dominant follicular diameter ≥ 14 mm, while a short GnRH-a protocol was adopted in the control group. Oocyte maturation was induced by human chorionic gonadotropin in both groups. All good quality embryos were cryopreserved for later transfer.Main Outcome Measures: The primary outcome was the incidence of premature luteinizing hormone (LH) surge. Secondary outcomes were the number of mature oocytes retrieved, good-quality embryo rate per oocyte retrieved, and clinical pregnancy rate following FET cycles.Results: No premature LH surge was detected during ovarian stimulation in the study group. There was no statistically significant difference in the number of mature oocytes between the two groups (10 ± 5.6 in the study group vs. 8.51 ± 5.03 in the control group, P = 0.11). Good-quality embryo rate per oocyte retrieved did not differ between the two groups: 40.18% (313/779) vs. 36.67% (253/690), P = 0.167. Clinical pregnancy rate per transfer following FET was comparable between the two groups (61.33 vs. 52.5%, P = 0.267).Conclusions: Our study shows that ovarian stimulation initiated in the late follicular phase using hMG alone may be a feasible alternative for normal-ovulatory women undergoing IVF/ICSI treatment with the freeze-all strategy.

Gonadotropin-releasing hormone antagonist versus progestin for the prevention of premature luteinising hormone surges in poor responders undergoing in vitro fertilisation treatment: study protocol for a randomised controlled trial

BackgroundProgress in vitrification techniques has allowed reproductive physicians to consider new strategies for using progestin as an alternative to a GnRH analogue to improve in vitro fertilisation (IVF). However, the role of progestin in blocking luteinising hormone (LH) surges and its potential in clinical practice are unclear, especially for poor responders. We designed a prospective randomised controlled trial (RCT) to compare the efficacy of a gonadotropin-releasing hormone (GnRH) antagonist and progestin in blocking LH surges and premature ovulation in poor responders.Methods/designPoor responders who meet the Bologna criteria will be randomised to one of two stimulation regimens—gonadotropin-releasing hormone (GnRH) antagonist or progestin-primed ovarian stimulation (PPOS)—using a computer-generated random number. Fresh embryos were transferred in the GnRH antagonist group and frozen embryos were transferred in the PPOS group. The primary outcome is the incidence of premature LH surges. Secondary outcomes include the number of oocytes retrieved, the number of embryos available for transfer, implantation rates and clinical pregnancy. The sample size for this trial is estimated as 340 participants, with 170 participants in each group. The data analysis will be by intention to treat.DiscussionTo our knowledge, this is the first RCT to examine the efficacy of administering progestin orally to block LH surges and premature ovulation compared with the GnRH antagonist protocols in poor responders undergoing IVF treatment.Trial registrationwww.chictr.org.cn. ChiCTR-IPR-17010906. Registered on 18 March 2017.

Luteal phase stimulation is associated with lower peak estradiol levels and less GNRH antagonist use while yielding the same outcomes as conventional follicular phase stimulation

Elevated levels of estradiol are associated with an increase in the incidence of ovarian hyperstimulation syndrome (OHSS) in women undergoing IVF treatment. GnRH antagonists are frequently used in conventional antagonist protocols to prevent a premature luteinizing hormone (LH) surge, though they are known to be invasive and costly. We hypothesize that an alternative protocol initiating stimulation in the luteal phase, wherein progesterone may serve as a natural inhibitor of the LH surge, in combination with an aromatase inhibitor, may be a comparable protocol for women undergoing IVF who are at risk for OHSS. Additional benefits to using this protocol include fewer medication costs to the patient and decreased chance of cycle cancellation due to OHSS. The purpose of this study was to compare peak estradiol levels, duration of GnRH antagonist use, and oocyte yield in a luteal phase stimulation compared to a conventional follicular phase stimulation protocol. This was a retrospective study in a private IVF program examining 56 patients treated with either a standard follicular phase stimulation or luteal phase stimulation between January and October 2017. We included all women with ovulatory cycles, age < 39, BMI < 30 kg/m2, and CD3 FSH < 9. Luteal phase protocol consisted of daily 250 IU Follistim, 5 IU microdose hcg and 5mg daily letrozole initiated after spontaneous ovulation or inducing with 200mg vaginal progesterone twice daily. GnRH antagonist (ganirelix acetate or cetrorelix acetate) was initiated when leading follicle size >15mm or when E2 levels were > 200 pg/mL. Baseline characteristics were collected for all patients and the primary outcomes measured were oocyte yield, duration of GnRH antagonist use, and peak E2 levels. Baseline characteristics were similar between both protocol groups. Peak estradiol levels were 647 and 4669 pg/mL in luteal and conventional stimulations, respectively (p <0.01). GnRH antagonist was administered for 3.3 days in luteal protocols compared to 5.4 days in a conventional protocol, while the total number of stimulation days were similar (11.3 vs 10.1, p = 0.29). The average oocyte yield between antagonist and luteal stimulations was not significantly different (12.9 vs 13.6, p=0.72) (Table 1). No cases of premature luteinization, ovulation, or OHSS were observed in either group.Tabled 1Table 1ParameterStimulation ProtocolP-valueAntagonist(n=29)Luteal(n=27)Maternal age (range)34.4 (25-39)33.7 (26-39)0.43CD 3 FSH6.96.00.44BMI22.522.30.82Stim duration (d)10.111.3<0.01*GnRH antagonist duration (d)5.43.2<0.01*Stim day at time of GnRHa start5.79.1<0.01*Peak E2 (pg/ml)4669.9656.3<0.01*# oocytes retrieved13.612.70.60*p<0.05 Open table in a new tab *p<0.05 Luteal phase stimulation with use of letrozole is associated with significantly lower peak estradiol level while producing similar competent oocytes compared to conventional follicular phase stimulation. This protocol may be preferred for women at higher risk of developing OHSS or for women with endometriosis. In addition, progesterone exposure during the luteal phase can be used to prevent premature luteinization, therefore requiring fewer GnRH antagonist injections and reducing cost.

Clomiphene citrate in LH surge suppression for women undergoing ICSI

Abstract Objective To evaluate the effect of adding clomiphene citrate (CC) in the mid-to-late follicular phase as an adjuvant to gonadotropins to suppress luteinizing hormone (LH) surge in women undergoing intracytoplasmic sperm injection (ICSI). Methods Prospective non-randomized study of 108 women undergoing ICSI and subjected to ovarian stimulation with gonadotropins with addition of CC (50 mg 3 times per day) when a leading follicle reached 14 mm in diameter and continued till the day of human chorionic gonadotropin (HCG) administration. Women subjected to controlled ovarian stimulation (COS) with the gonadotropin-CC protocol (n = 50) were compared with a group of women were to COS with the flexible gonadotropin releasing hormone antagonist (GnRH-ant) protocol (n = 58). Results Serum LH level on day HCG administration was significantly higher in CC group than in GnRH-ant group and the incidence of LH surge was higher in CC group than in GnRH-ant group (10% vs 3.4%, respectively) but without statistically significant difference (P = .246). The oocyte maturation and fertilization rates, the biochemical and clinical pregnancy rates, the implantation rate and the ongoing pregnancy rate were comparable in both groups. Conclusion Adding CC in the mid-to-late follicular phase as an adjuvant to gonadotropins represents a less costly COS which is effective in eliminating the occurrence of premature LH surge without compromising the cycle outcomes in women undergoing ICSI.

Effects of clomiphene citrate for prevention of premature luteinizing hormone surge in those undergoing intrauterine insemination outcome: A randomized, double-blind, placebo-controlled trial.

The objective of the study is to determine the effects of clomiphene citrate (CC) on preventing premature luteinizing hormone (LH) surge in infertile patients with polycystic ovary syndrome (PCOS) undergoing intrauterine insemination (IUI). This was a randomized clinical trial being performed at Shiraz Mother and Child Hospital. We included 162 women with PCOS selected for IUI cycles. Patients were randomly allocated to receive 150 mg/day CC from the 8th of the cycle though the day of human chorionic gonadotropin (hCG) injection (n = 81) or nothing in the same period (n = 81). Main outcomes included the incidence of premature LH surge, pregnancy rate, abortion and ongoing pregnancy rates, number of maturing follicles, and endometrial thickness. The incidence of premature LH surge was significantly lower in those who received CC (3.0% vs. 14.9%; P = 0.021). The pregnancy rate was 10 (15.1%) and 6 (8.9%) in CC and control groups, respectively (P = 0.342). The ongoing pregnancy rate found to be comparable between two study groups (12.1% vs. 5.9%; P = 0.068). Serum level of estradiol (E2) level at the time of hCG administration was significantly higher in those who were treated with CC when compared to control (1153.5 ± 326.4 vs. 943.2 ± 215.3; P < 0.001). Patients who received CC also had higher number of mature follicles >18 mm when compared to controls (3.85 ± 1.3 vs. 2.94 ± 1.01; P < 0.001). Administration of CC from the 8th day of the cycle to the day of hCG injection in combination with Gonal-f in infertile patients with CC-resistant PCOS undergoing IUI cycles is associated with decreased incidence of premature LH surge, higher E2levels, and higher number of mature ovarian follicles. This protocol is safe and simple and could be considered to be cost-effective.

Comparison of Two Regimens of Gonadotropin-releasing Hormone Antagonists in Clomiphene-gonadotropin Induced Controlled Ovulation and Intrauterine Insemination Cycles: Randomized Controlled Study.

Context:Gonadotropin-releasing hormone (GnRH) antagonists in fixed or flexible regimens are used for prevention of premature luteinizing hormone (LH) surge, however, data comparing these regimens in stimulated intrauterine insemination (IUI) cycles are lacking.Aims:The aim of this study is to evaluate the effectiveness of GnRH antagonists in fixed and flexible regimens on the rate of premature luteinization (PL) and ovulation rate in sequential clomiphene-gonadotropin controlled ovulation–IUI cycles.Settings and Design:This study was conducted at tertiary care center; this was randomized controlled study.Materials and Methods:A total of 45 infertile women randomized into three groups of 15 each received clomiphene citrate + human menopausal gonadotrophin. GnRH antagonist was added according to fixed (n = 15) and flexible (n = 15) protocol. No antagonist in control group (n = 15). PL was defined as LH level ≥10 mIU/ml and progesterone level ≥1.0 ng/ml.Statistical Analysis:Mean values compared using the Student's t-test or one-way analysis of variance. Categorical variables distribution tested using either Pearson's Chi-square or Fisher's exact test as appropriate.Results:Of a total of 45 women, 58% (n = 26) presented with primary and 42% (n = 19) secondary infertility with mean age of 30.8 ± 3.43 years and BMI 26.57 ± 3.22 kg/m2. Fixed regimen (3.7%) showed most reduction in PL compared to flexible (15.38%, P = 0.33) or control (36.67%, P = 0.004). On human chorionic gonadotropin day, mean LH (P = 0.002) and progesterone (P = 0.079) levels in fixed, flexible, and control groups were as follows: 5.04 ± 5.47 mIU/ml, 3.95 ± 4.16 mIU/ml, 9.57 ± 7.91 mIU/ml, and 0.409 ± 0.320 ng/ml, 0.579 ± 0.727 ng/ml, and 1.033 ± 1.022 ng/ml, respectively. Ovulation (P = 0.813) and pregnancy rates (P = 0.99) were 88.9%, 84.6%, and 90% and 22.2%, 19.23%, and 10% in fixed, flexible, and control groups, respectively.Conclusions:Addition of antagonist in any regimen appears to lower PL rates and improve pregnancy rates in controlled ovarian stimulation and IUI cycles.

Desogestrel for preventing a premature luteinizing hormone (LH) surge in a cycle for oocyte cryopreservation

Objectives:The advance of cryopreservation techniques turn possible the use of new strategies for LH supression during in vitro fertilization (IVF) cycles. Methods: The use of progesterone instead of gonadotropin-releasing hormone (GnRH) analogues seems to be a feasible option. Desogestrel is a progesterone broadly known and accepted in the context of contraception, with a good tolerability and low cost, in addition to a potent anti-ovulatory potency. Results: The present case is the first describing a succesfully controlled ovarian hyperstimulation (COH) for social oocyte cryopreservation using desogestrel 75mcg as a LH blocker in a healthy 35-year-old woman. Conclusions: the use of progesterone for LH supression seems to be a great option in the context of oocyte cryopreservation, since it is safe, less expensive and patient-friendly, avoiding the daily injections of GnRH analogues.

Recombinant luteinizing hormone (rLH) and recombinant follicle stimulating hormone (rFSH) for ovarian stimulation in IVF/ICSI cycles.

Recombinant luteinizing hormone (rLH) and recombinant follicle stimulating hormone (rFSH) for ovarian stimulation in IVF/ICSI cycles.

A Patient Friendly Corifollitropin Alfa Protocol without Routine Pituitary Suppression in Normal Responders.

The release of corifollitropin alfa simplifies daily injections of short-acting recombinant follicular stimulating hormone (rFSH), and its widely-used protocol involves short-acting gonadotropins supplements and a fixed GnRH antagonist regimen, largely based on follicle size. In this study, the feasibility of corifollitropin alfa without routine pituitary suppression was evaluated. A total of 288 patients were stimulated by corifollitropin alfa on cycle day 3 following with routine serum hormone monitoring and follicle scanning every other day after 5 days of initial stimulation, and a GnRH antagonist (0.25 mg) was only used prophylactically when the luteinizing hormone (LH) was ≧ 6 IU/L (over half of the definitive LH surge). The incidence of premature LH surge (≧ 10 IU/L) was 2.4% (7/288) before the timely injection of a single GnRH antagonist, and the elevated LH level was dropped down from 11.9 IU/L to 2.2 IU/L after the suppression. Two hundred fifty-one patients did not need any antagonist (87.2% [251/288]) throughout the whole stimulation. No adverse effects were observed regarding oocyte competency (fertilization rate: 78%; blastocyst formation rate: 64%). The live birth rate per OPU cycle after the first cryotransfer was 56.3% (161/286), and the cumulative live birth rate per OPU cycle after cyrotransfers was 69.6% (199/286). Of patients who did and did not receive GnRH antagonist during stimulation, no significant difference existed in the cumulative live birth rates (78.4% vs. 68.3%, p = 0.25). The results demonstrated that the routine GnRH antagonist administration is not required in the corifollitropin-alfa cycles using a flexible and hormone-depended antagonist regimen, while the clinical outcome is not compromised. This finding reveals that the use of a GnRH antagonist only occasionally may be needed.

Dose-finding study of Leuplin depot for prevention of premature luteinizing hormone surge during controlled ovarian stimulation: a pilot study in intrauterine insemination treatment

ObjectiveThe standard dose of depot gonadotropin releasing hormone agonist (GnRHa) may be too much to prevent premature luteinizing hormone (LH) surge in controlled ovarian stimulation (COS). The purpose of this study was to find out the minimal effective dose of Leuplin depot to prevent premature LH surge in patients undergoing intrauterine insemination (IUI). Materials and MethodsFrom January 2006 to December 2007, unexplained infertile patients who were going to undergo IUI were recruited into the study. They were assigned sequentially to one of the following treatment groups. The first 50 patients received the 1/3-dose of Leuplin depot in the midluteal phase of the cycle preceding COS. If no premature LH surge occurred in the 50 patients, the study was continued with 1/4-dose of Leuplin depot in the subsequent 50 patients. Similarly, if no premature LH surge occurred with 1/4 dose, the study was continued with 1/5-dose of Leuplin depot in the following 50 patients. Ovarian stimulation was started with human menopausal gonadotropin (hMG) at 112.5 IU/d after downregulation, then IUI was performed 36 hours after human chorionic gonadotropin (hCG) injection. ResultsPremature LH surge was effectively prevented with 1/3-dose and 1/4-dose of Leuplin depot. Premature LH surge occurred in three of the 50 patients (6%) in the 1/5-dose group. The patients in the 1/4-dose group received a significantly lower amount of hMG and fewer days of COS, compared with the 1/3-dose group. ConclusionThe 1/4 dose of Leuplin depot is the minimal effective dose to prevent premature LH surge. Further trial is worthwhile to compare the reducing dose Leuplin depot and daily low-dose leuprolide in in vitro fertilization (IVF) programs.

A simple method of extended 8 days course of clomiphene citrate versus 5 days course in an attempt to suppress premature luteinizing hormone surge in an assisted reproductive technology program: A randomized controlled trial

Objective: To determine whether the use of prolonged, 8 days course of clomiphene citrate (CC) versus the standard use of 5 days is an effective method to prevent premature luteinizing hormone (LH) surge in assisted reproductive technology (ART) program. Materials and Methods: Eligible participants were randomized into one of the two treatment groups, In Group A, the patients received CC 100 mg for 5 days from cycle day 3-7 plus human menopausal gonadotropin (hMG), 150-225 IU on alternate days. In Group B, patients received CC 100 mg for 8 days from cycle day 3-10 plus hMG. Cycles were monitored with ultrasound and urinary LH tests only. Results: Two hundred and thirty-eight patients were randomized, but a total of 227 were analyzed. The percentage risk of premature LH surge was similar in both groups with (20% Group A vs. 24% Group B, P = 0.6) and there was no significant difference in live birth and clinical pregnancy rates per initiated cycle between the two groups, 6.4% Group A versus 10.6% in Group B and 12% (a) versus 17% (b), respectively. Cycle cancellation rates were also similar between the two groups, 36% (a) versus 31% (b). Conclusion: The trial shows that prolonged, 8 days course of CC does not suppress premature LH surge in ART program.

Gonadotrophin-releasing hormone agonist protocols for pituitary suppression in assisted reproduction.

Gonadotrophin-releasing hormone agonist protocols for pituitary suppression in assisted reproduction.

Effects of Letrozole in Prevention of Premature Luteinizing Hormone (LH) Surge in Infertile Women with Clomiphene Citrate Resistant Polycystic Ovary Syndrome (PCOS) Undergoing Intrauterine Insemination

Background: Polycystic ovarian syndrome (PCOS) is among the important causes of infertility in young women. Premature luteinizing hormone (LH) surge (PLS) is one of its complications. PLS can reduce the quality of oocytes and therefore decrease the success of intrauterine insemination (IUI). Letrozole, a non-steroidal aromatase inhibitor, prevents LH surge. In this study, we aim to evaluate the effects of letrozole on preventing premature LH surge in clomiphene-resistant patients with PCOS undergoing IUI. Materials and Methods: In this randomized clinical trial, 131 patients who were developed with PCOS were selected for IUI cycle, divided into two groups randomly: control group (n=67) and letrozole group (n=64). Incidence of premature LH surge, pregnancy, abortion and ongoing pregnancy rate, endometrial thickness and number of follicles were measured in both groups. Results: No significant difference was seen between mean ages in the two groups; 11.9% of the control group and 21.9% of the letrozole group became pregnant (P =0.005); furthermore, premature LH surge was seen in 4.7% of the letrozole group and 8.9% of the control group (P =0.003). E2 and Endometrial thickness was higher in letrozole group; however, LH was significantly higher in the control group (P =0.026). Conclusion: Administration of letrozole in clomiphene-resistant patients with PCO undergoing IUI cycle can decrease the incidence of PLS. In addition, it can increase pregnancy rate significantly. Therefore, using letrozole is more reasonable in patients who have not responded to clomiphene or are hypersensitive. [GMJ.2015;4(3):104-11]

Shifting paradigms in diminished ovarian reserve and advanced reproductive age in assisted reproduction: customization instead of conformity.

As women are increasingly delaying childbearing into their 30s and beyond, diminished ovarian reserve (DOR) and advanced reproductive age (ARA) patients are bound to become a large proportion of all assisted reproductive technology practices. Traditional controlled ovarian stimulation (COS) protocols for DOR and/or ARA have had some limited success, but pregnancy rates are lower and cycle cancellation rates are higher than their younger counterparts with normal ovarian reserve. Though many physicians have a selection of favorite standard protocols that they use, patients with DOR may require closer monitoring and customization of the treatment cycle to address the common problems that come with low ovarian reserve. Frequent issues that surface in women with DOR and/or ARA include poor follicular response, premature luteinizing hormone surge, and poor embryo quality. Limited published evidence exists to guide treatment for DOR. However, use of minimal or mild doses of gonadotropins, avoidance of severe pituitary suppression, and consideration for luteal phase stimulation and a "freeze all" approach are possible customized treatment options that can be considered for such patients who have failed more traditional COS protocols.

Utrogestan as an effective oral alternative for preventing premature luteinizing hormone surges in women undergoing controlled ovarian hyperstimulation for in vitro fertilization.

A major cause of cycle cancellation during controlled ovarian hyperstimulation (COH) in women undergoing in vitro fertilization (IVF) is the occurrence of premature luteinizing hormone (LH) surges. Steroidal preparations can modulate the secretion of gonadotropins (Gn); however, few studies using progesterone to inhibit the premature LH surges in COH have been published. The purpose of the study was to evaluate the oral delivery of progesterone soft capsules (Utrogestan) to prevent LH surges from the follicular phase and to compare cycle characteristics as well as to evaluate pregnancy outcomes in subsequent frozen-thawed embryo transfer (FET) cycles.A total of 374 patients were enrolled in this retrospective study, among which 187 patients were simultaneously administered Utrogestan and human menopausal gonadotrophin (hMG) from cycle day 3 until the trigger day. A short protocol including 187 controls with comparable age, body mass index (BMI), infertility duration, and antral follicle count was also used. GnRH agonist (0.1 mg) or hCG (3000 IU) was used for a trigger when the dominant follicles matured. Viable embryos were cryopreserved for later transfer in both groups. The primary outcome was the number of oocytes retrieved. The secondary outcomes included the number of mature oocytes, incidence of premature LH surge, and clinical pregnancy outcomes from FET cycles.Consistent LH suppression was achieved during COH, with a range of 0.07 to 8.9 IU/L, and no premature LH surge was detected. The number of oocytes retrieved in the Utrogestan and hMG protocol was comparable with that in the short protocol (10.92 ± 5.74 vs 10.6 ± 6.22, P > 0.05), and the dose of hMG was higher than that used in the short protocol (1884.22 ± 439.47 IU vs 1446.26 ± 550.48 IU, P < 0.05). No significant between-group difference was observed in the mature oocyte rate (88.88% vs 90.12%), cleavage rate (96.58% vs 96.58%), clinical pregnancy rate (54.27% vs 51.65%), or implantation rate (33.59% vs 34.02%).The study shows that Utrogestan is an effective oral alternative for preventing premature LH surges in women undergoing COH, which will help to establish a convenient user regimen in combination with FET.

Efficacy of corifollitropin alfa followed by recombinant follicle-stimulating hormone in a gonadotropin-releasing hormone antagonist protocol for Korean women undergoing assisted reproduction

ObjectiveTo evaluate the effect of a gonadotropin-releasing hormone (GnRH) antagonist protocol using corifollitropin alfa in women undergoing assisted reproduction.MethodsSix hundred and eighty-six in vitro fertilization-embryo transfer (IVF)/intracytoplasmic sperm injection (ICSI) cycles were analyzed. In 113 cycles, folliculogenesis was induced with corifollitropin alfa and recombinant follicle stimulating hormone (rFSH), and premature luteinizing hormone (LH) surges were prevented with a GnRH antagonist. In the control group (573 cycles), premature LH surges were prevented with GnRH agonist injection from the midluteal phase of the preceding cycle, and ovarian stimulation was started with rFSH. The treatment duration, quality of oocytes and embryos, number of embryo transfer (ET) cancelled cycles, risk of ovarian hyperstimulation syndrome (OHSS), and the chemical pregnancy rate were evaluated in the two ovarian stimulation protocols.ResultsThere were no significant differences in age and infertility factors between treatment groups. The treatment duration was shorter in the corifollitropin alfa group than in the control group. Although not statistically significant, the mean numbers of matured (86.8% vs. 85.1%) and fertilized oocytes (84.2% vs. 83.1%), good embryos (62.4% vs. 60.3%), and chemical pregnancy rates (47.2% vs. 46.8%) were slightly higher in the corifollitropin alfa group than in the control group. In contrast, rates of ET cancelled cycles and the OHSS risk were slightly lower in the corifollitropin alfa group (6.2% and 2.7%) than in the control group (8.2% and 3.5%), although these differences were also not statistically significant.ConclusionAlthough no significant differences were observed, the use of corifollitropin alfa seems to offer some advantages to patients because of its short treatment duration, safety, lower ET cancellation rate and reduced risk of OHSS.

Review on Antagonists

ABSTRACTGonadotropin-releasing hormone (GnRH) antagonists have been a breakthrough in reproductive medicine. The third generation antagonists (cetrorelix and ganirelix) do not have histamine releasing capability in the used doses. The competitive blockade of GnRH receptors by GnRH antagonists leads to an immediate but reversible arrest of gonadotropin secretion. Antagonists can be used as single-dose or multiple dose protocol in a fixed or flexible approach during ovarian stimulation to prevent premature luteinizing hormone surge. The stimulation remains close to the normal cycle, and more convenient and friendly to the patient with lesser dose and duration of stimulation. Recent Cochrane analysis suggests that there is no significant difference in the live birth rate when antagonists are compared with agonists (OR 0.86) and there is a significant reduction in the incidence of ovarian hyperstimulation syndrome (OHSS) (OR 0.43) with the use of antagonists. Gonadotropin-releasing hormone antagonists are of special benefit for use in patients with polycystic ovaries where agonist trigger can be used and OHSS can be prevented completely. Gonadotropin-releasing hormone antagonists have particular advantage in poor responders with lesser pituitary suppression in the early part of cycle. Gonadotropinreleasing hormone antagonists can be used in modified natural cycle, intrauterine insemination cycles, and frozen embryo transfer cycles. Novel uses of antagonists include suppression of established OHSS, and in various gynecological conditions (endometriosis, fibroids, precocious puberty).How to cite this articleSardana D. Review on Antagonists. Int J Infertil Fetal Med 2015;6(1):1-10.