OBJECTIVE: To investigate the impact on the number of cumulus-oocyte complexes (COC) when a 3-day course of GnRH antagonist treatment precedes the initiation of controlled ovarian stimulation with gonadotropins in a GnRH antagonist protocol for IVF/intracytoplasmic sperm injection (ICSI). DESIGN: Randomized controlled trial. SETTING: Tertiary referral center. PATIENT(S): Sixty-nine women undergoing controlled ovarian hyperstimulation for IVF/ICSI. INTERVENTION(S): The control group (n = 36) received a standard treatment with daily injections of recombinant FSH (rFSH), starting on day 2 of the cycle at a dose of 150-225 IU/day, and GnRH antagonists from cycle day 7 onward. In the pretreatment group (n = 33), a GnRH antagonist was administered from day 2 of the menstrual cycle onward during 3 consecutive days; thereafter controlled ovarian stimulation was initiated with the same protocol as used in the control group. MAIN OUTCOME MEASURE(S): The primary endpoint was the number of COCs at egg retrieval. RESULT(S): Both groups had comparable baseline characteristics. The duration of rFSH stimulation and consumption of gonadotropins were similar in both groups. The number of COCs was higher in the pretreatment group (12.8; SD, 7.8) compared with in the control group (9.9; SD, 4.9), although this increment was not significant (between-group difference of 2.9 [95% confidence interval {CI} -0.2 to 6.0]). The ongoing pregnancy rates per started cycle of 14/33 (42%) versus 12/36 (33%) for pretreatment versus control did not differ significantly (between-group difference, 9.1%; 95% CI, -13% to 30%). CONCLUSION(S): Among women under 36 years old, early follicular phase GnRH antagonist pretreatment in afixed GnRH antagonist protocol results in a trend toward a higher number of retrieved oocytes but does not yield significantly higher pregnancy rates.
RCT Entities:
OBJECTIVE: To investigate the impact on the number of cumulus-oocyte complexes (COC) when a 3-day course of GnRH antagonist treatment precedes the initiation of controlled ovarian stimulation with gonadotropins in a GnRH antagonist protocol for IVF/intracytoplasmic sperm injection (ICSI). DESIGN: Randomized controlled trial. SETTING: Tertiary referral center. PATIENT(S): Sixty-nine women undergoing controlled ovarian hyperstimulation for IVF/ICSI. INTERVENTION(S): The control group (n = 36) received a standard treatment with daily injections of recombinant FSH (rFSH), starting on day 2 of the cycle at a dose of 150-225 IU/day, and GnRH antagonists from cycle day 7 onward. In the pretreatment group (n = 33), a GnRH antagonist was administered from day 2 of the menstrual cycle onward during 3 consecutive days; thereafter controlled ovarian stimulation was initiated with the same protocol as used in the control group. MAIN OUTCOME MEASURE(S): The primary endpoint was the number of COCs at egg retrieval. RESULT(S): Both groups had comparable baseline characteristics. The duration of rFSH stimulation and consumption of gonadotropins were similar in both groups. The number of COCs was higher in the pretreatment group (12.8; SD, 7.8) compared with in the control group (9.9; SD, 4.9), although this increment was not significant (between-group difference of 2.9 [95% confidence interval {CI} -0.2 to 6.0]). The ongoing pregnancy rates per started cycle of 14/33 (42%) versus 12/36 (33%) for pretreatment versus control did not differ significantly (between-group difference, 9.1%; 95% CI, -13% to 30%). CONCLUSION(S): Among women under 36 years old, early follicular phase GnRH antagonist pretreatment in a fixed GnRH antagonist protocol results in a trend toward a higher number of retrieved oocytes but does not yield significantly higher pregnancy rates.
Authors: Evangelos G Papanikolaou; Hakan Yarali; Evi Timotheou; Michael Grynberg; Odysseas Zafeiratis; Herman Tournaye; Robert Najdecki Journal: Front Endocrinol (Lausanne) Date: 2018-03-01 Impact factor: 5.555
Authors: The Eshre Guideline Group On Ovarian Stimulation; Ernesto Bosch; Simone Broer; Georg Griesinger; Michael Grynberg; Peter Humaidan; Estratios Kolibianakis; Michal Kunicki; Antonio La Marca; George Lainas; Nathalie Le Clef; Nathalie Massin; Sebastiaan Mastenbroek; Nikolaos Polyzos; Sesh Kamal Sunkara; Tanya Timeva; Mira Töyli; Janos Urbancsek; Nathalie Vermeulen; Frank Broekmans Journal: Hum Reprod Open Date: 2020-05-01