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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.

  • Chapter 17 - In vitro maturation of oocytes

  • from Section 5: - Alternatives to ovarian hyperstimulation
  • Edited by Mohamed Aboulghar, Botros Rizk, University of South Alabama
  • Book:
    Ovarian Stimulation
    Published online:
    05 August 2011
    Print publication:
    23 December 2010, pp 181-194

  • Summary

    Management of the poor responder remains one of the greatest challenges of controlled ovarian hyperstimulation (COH) in preparation for the assisted reproductive technologies. This chapter reviews a variety of approaches which have been employed in this poorly defined patient group. The profound suppression of gonadotropins induced by traditional long luteal gonadotropin-releasing hormone agonist (GnRHa) protocols may be particularly devastating for poor responders. Decreasing the GnRHa dose during the luteal phase prior to COH would theoretically decrease the extent of endogenous gonadotropin suppression while preventing premature ovulation. The administration of estradiol in the luteal phase may induce follicle-stimulating hormone (FSH) receptor formation in more resistant follicles and result in a more coordinated gonadotropin response. The ability to enhance endogenous follicular phase gonadotropin release by the administration of either clomiphene citrate or an aromatase inhibitor would represent an attractive adjunct to GnRHant protocols in poor-responder patients.

  • 30 - Medical Management of Polycystic Ovary Syndrome

  • 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 286-293

  • Summary

    This chapter discusses polycystic ovary syndrome (PCOS) and its clinical manifestations. It also explores the incidence of insulin resistance in PCOS. Insulin resistance can be encountered in women with PCOS. Diagnosis and treatment are also independent on insulin resistance. Management of women with PCOS depends on the symptoms. These could be ovulatory dysfunction-related infertility, menstrual disorders, or hirsutism. Treatment of hirsutism involves administration of oral contraceptive pills and antiandrogens. Clomiphene citrate, dexamethazone, gonadotropin and aromatase inhibitors are used in the treatment of ovulatory disorders. Gonadotropin-releasing hormone agonist plays a major role in IVF treatment as well as in superovulation. There are several insulin-sensitizing agents available to reduce insulin levels, and the most commonly used for women with PCOS is metformin. Metformin has replaced the surgical treatment of PCOS with ovarian drilling. Metformin improves insulin resistance and hyperandrogenism, decreases serum lipids, and improves glucose homeostasis.