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3 results

  • Live birth rate of gonadotropin-releasing hormone antagonist versus luteal phase gonadotropin-releasing hormone agonist protocol in IVF/ICSI: a systematic review and meta-analysis

  • Chenhong Liu, Tian Tian, Yanru Lou, Jia Li, Ping Liu, Rong Li, Jie Qiao, Yuanyuan Wang, Rui Yang
  • Journal:
    Expert Reviews in Molecular Medicine / Volume 26 / 2024
    Published online by Cambridge University Press:
    14 December 2023, e2
    • Article
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  • In vitro fertilization (IVF) and embryo transfer and intracytoplasmic sperm injection (ICSI) have allowed millions of infertile couples to achieve pregnancy. As an essential part of IVF/ICSI enabling the retrieval of a high number of oocytes in one cycle, controlled ovarian stimulation (COS) treatment mainly composes of the standard long gonadotrophin-releasing hormone agonist (GnRH-a) protocol and the gonadotrophin-releasing hormone antagonist (GnRH-ant) protocol. However, the effectiveness of GnRH-ant protocol is still debated because of inconsistent conclusions and insufficient subgroup analyses. This systematic review and meta-analysis included a total of 52 studies, encompassing 5193 participants in the GnRH-ant group and 4757 in the GnRH-a group. The findings of this study revealed that the GnRH-ant protocol is comparable with the long GnRH-a protocol when considering live birth as the primary outcome, and it is a favourable protocol with evidence reducing the incidence of ovarian hyperstimulation syndrome in women undergoing IVF/ICSI, especially in women with polycystic ovary syndrome. Further research is needed to compare the subsequent cumulative live birth rate between the two protocols among the general and poor ovarian response patients since those patients have a lower clinical pregnancy rate, fewer oocytes retrieved or fewer high-grade embryos in the GnRH-ant protocol.

  • 33 - Medical Management of Endometriosis

  • from PART II - INFERTILITY EVALUATION AND TREATMENT
  • Edited by Botros R. M. B. Rizk, University of South Alabama, Juan A. Garcia-Velasco, Hassan N. Sallam, Antonis Makrigiannakis, University of Crete
  • Book:
    Infertility and Assisted Reproduction
    Published online:
    04 August 2010
    Print publication:
    15 September 2008, pp 309-317

  • Summary

    The successful treatment of endometriosis-associated symptoms typically requires surgical as well as medical intervention. Progestogens are efficacious and inexpensive treatment of pelvic endometriosis. A variety of medications have been used as add-back therapy in addition to gonadotrophin-releasing hormone (GnRH) agonist for treatment of endometriosis which includes progestogen alone, progestogen and estrogen combination, or progestogen and bisphosphonates. GnRH antagonists have been used for the treatment of pelvic endometriosis; however, they have not been as widely accepted as GnRH agonists. Selective progesterone receptor modulators introduce a new dimension in the medical treatment of endometriosis. Aromatase inhibitors which inhibit estrogen production in endometriotic implants are an attractive option for the management of endometriosis. Antiangiogenesis therapy has been investigated in rodents, demonstrated that angiostatic agents prevent the development of endometriosis-like lesions in the chicken chorioallantoic membrane. Nonsteroidal inflammatory drugs are very helpful in pelvic pain and dysmenorrhea associated with endometriosis.

  • 43 - Evidence-Based Medicine Comparing hMG/FSH and Agonist/Antagonist and rec/Urinary hCG/LH/GnRH to Trigger Ovulation

  • from PART III - ASSISTED REPRODUCTION
  • Edited by Botros R. M. B. Rizk, University of South Alabama, Juan A. Garcia-Velasco, Hassan N. Sallam, Antonis Makrigiannakis, University of Crete
  • Book:
    Infertility and Assisted Reproduction
    Published online:
    04 August 2010
    Print publication:
    15 September 2008, pp 386-394

  • Summary

    This chapter compares the role of human menopausal gonadotrophin (hMG), follicle-stimulating harmone (FSH) agonist/antagonist and recombinant/urinary human chorionic gonadotrophin (hCG)/luteinizing hormone (LH)/gonadotrophin-releasing hormone agonist (GnRHa) in triggering ovulation. With the use of GnRHa, hCG was necessary to induce final follicular maturation and triggering of ovulation. Accordingly, in the 1980s, the use of gonadotrophins, GnRHa, and hCG became a standard successful protocol for ovulation induction in assisted conception cycles. The GnRH antagonists emerged as an alternative to GnRHa in preventing premature LH surges. Recombinant FSH (recombinant-human FSH), which is free of LH activity, is used in many cases of controlled ovarian hyperstimulation (COH) after downregulation with long protocol. The conclusions of the meta-analyses are that there is no advantage for either recombinant FSH or urinary FSH concerning the clinical pregnancy rate, miscarriage rate, or ovarian hyperstimulation syndrome (OHSS) rate.