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Late hCG administration yields more good quality embryos and favors the overall IVF outcome  [PDF]
Pu Zhang, Kjell W?nggren
Open Journal of Obstetrics and Gynecology (OJOG) , 2012, DOI: 10.4236/ojog.2012.24070
Abstract: Context: Optimal timing of hCG administration is a crucial step for successful IVF. Currently used standard hCG administration timing is not always practically possible due to weekends break or other reasons. Sometimes hCG needs to be administrated earlier or later than standard timing. Aim: To find out whether earlier or later hCG administration gives better IVF outcome. Setting and Design: A retrospective study on patients who underwent conventional IVF treatment. Methods and Material: Based on hCG timing, the patients were divided into three groups: the early hCG group where the hCG was given when less than three follicles ≥ 17 mm; the standard hCG group where the hCG was given when three or more follicles ≥ 17 mm; and the late hCG group where the hCG was given 1 to 3 days after the standard timing. The number of retrieved mature oocytes, the fertilization rate, the number of good quality embryos, the pregnancy rate and the live birth rate were compared among three groups. Statistical Analysis: x2 test, fisher exact test and Student t-test were used. Results: in total, 289 patients, 305 IVF cycles and 2784 oocytes were analyzed. The late hCG group has significantly larger number of MII oocytes, fertilized oocytes and good quality embryos per IVF cycle, when compared with the early hCG group. The fertilization rate, the pregnancy rate and the live birth rate per IVF cycle were similar among the three groups. Conclusion: Although the delayed administration of hCG did not favor IVF outcome per IVF cycle, the cumulative pregnancy rate is likely to be improved with consideration of higher yield of good quality embryos.
GnRH Antagonist Protocol: Is It Optimal for All Patients of Different Ages Undergoing In Vitro Fertilization and Embryo Transfer?  [PDF]
Weijie Xing, Haiyan Lin, Qingxue Zhang
Advances in Sexual Medicine (ASM) , 2017, DOI: 10.4236/asm.2017.74012
Abstract: Background: To assess the effect of these two protocols in patients of different ages. Methods: 1923 in vitro fertilization and embryo transfer (IVF-ET) cycles were divided into two groups: a GnRH-ant protocol group and GnRH-a long protocol group, and then every group were subdivided into four age ranges. The general materials and IVF outcomes were compared. Results: The incidence of OHSS fluctuated from 0% to 2.37% with GnRH-ant protocol, which was significantly lower than another (P < 0.05). Of all age ranges, the implantation and clinical pregnancy rates with GnRH-ant protocol were all lower than those with GnRH-a protocol. When the age was less than 35 years old, the CPRs in GnRH-ant protocol group were significantly lower than in another group (45.56% vs. 62.29%, 46.07% vs. 55.59%, respectively; P < 0.05). Conclusion: The antagonist protocol should be considered in patients with a high ovarian response (e.g., PCOS patients) to avoid OHSS. Older patients (>35 years) could be treated with the antagonist protocol.
GnRH Antagonist Protocol: Is It Effective for Expected Poor Ovarian Responders with Tubal Factor Undergoing IVF?  [PDF]
Weijie Xing, Haiyan Lin, Qingxue Zhang
Advances in Reproductive Sciences (ARSci) , 2017, DOI: 10.4236/arsci.2017.54007
Abstract: Background: This study aimed to determine if the gonadotropin releasing hormone (GnRH) antagonist protocol is optimal for expected poor ovarian responders with tubal factor undergoing in vitro fertilization-embryo transfer (IVF-ET). Methods: A total of 341 IVF-ET cycles were retrospectively identified. The following inclusion criteria were applied: age ≥ 40 years and patients with tubal factors. The cycles were divided into two groups: a GnRH antagonist group (157 cycles) and a GnRH agonist group (184 cycles). Results: The duration of stimulation and the total doses of gonadotropin in the GnRH agonist group were significantly more than those in the GnRH antagonist group (P < 0.05). There were significant differences in LH and P values on the hCG measurement days between the two groups (0.91 ± 1.17 vs. 4.82 ± 4.69 U/L and 0.69 ± 0.42 vs. 1.03 ± 0.50 ng/mL, P < 0.05). The implantation rate of the GnRH antagonist group was 12.24%, which was slightly higher than that of the GnRH agonist group (10.10%, P = 0.437). The clinical pregnancy rate of the two groups showed no statistical differences (23.36% vs. 23.03%, P = 1.000). Conclusion: For expected poor ovarian responders, the GnRH antagonist protocol was, to some extent, superior to the GnRH agonist protocol in terms of the implantation and clinical pregnancy rates.
Effects of Short Term Administration of Genistein on Hypothalamic and Anterior Pituitary Hormones in Ovariectomized Gilts  [PDF]
Jeffrey Clapper, Carolyn Paulson
Open Journal of Animal Sciences (OJAS) , 2015, DOI: 10.4236/ojas.2015.52019
Abstract: Administration of genistein to barrows increased anterior pituitary (AP) concentrations of IGF-I and LH and increased expression of AP IGF receptor. Whether similar changes occur in gilts remains to be determined. The objective of this experiment was to determine if short term administration of genistein increased expression of components of the AP IGF system and hypothalamic hormones and receptors involved in gonadotropin synthesis and/or release in the gilt. Sixteen crossbred gilts of similar weight (97.7 kg) were ovariectomized and assigned to either control (C; n = 8) or genistein (G; n = 8) groups. Genistein pigs received 800 mg of genistein in DMSO while C pigs received an equal volume of DMSO i.m. on day 0, 1, 2, and 3. Blood samples were obtained on day 0, 1, 2, and 3. Pigs were slaughtered on d 4 when blood, AP, and medial basal hypothalami (MBH) were collected. No difference was detected (P > 0.05) in AP concentrations of IGF-I or serum concentrations of IGF-I in C and G pigs. Anterior pituitary concentrations of LH were greater (P < 0.05) in G pigs compared with C pigs. Relative expression of AP IGF-I was greater (P < 0.05) in G pigs than C pigs. Relative expression of AP IGF-IR, IGFBP-2 and IGFBP-3 did not differ (P > 0.05) in C and G pigs. Relative expression of AP IGFBP-5 and GnRHR was increased (P < 0.05) in G pigs compared with C pigs. Relative expression of AP LHβ did not differ between C and G pigs. Relative expression of MBH kisspeptin was greater (P < 0.01) in G pigs than C pigs. These data provided evidence that short term administration of genistein increased expression of hypothalamic and hypophyseal hormones in gilts which could influence subsequent reproduction.
Switching of GnRH Agent from Agonist to Antagonist in Patients with Castration-Resistant Prostate Cancer  [PDF]
Shinji Fukui, Yasushi Nakai, Yoriaki Kagebayashi, Shoji Samma
Open Journal of Urology (OJU) , 2016, DOI: 10.4236/oju.2016.612030
Abstract: Objectives: To evaluate the efficacy of alteration from gonadotropin-releasing hormone (GnRH) agonist to antagonist in patients with castration-resistant prostate cancer (CRPC). Methods: Fourteen patients with CRPC were switched from GnRH agonist to GnRH antagonist. CRPC was defined as 3 consecutive rises of PSA values under androgen deprivation therapy despite a testosterone level at the castration level. No patient underwent a change in oral anti-androgen agent or any additional therapy. Patients who showed increase of the PSA value within 10% or showed decrease in the PSA value compared to the baseline were defined as responders. We measured serum PSA, testosterone, follicular stimulating hormone (FSH), and leutenizing hormone (LH) at the time of alteration and 3 months after alteration. Results: The mean age at diagnosis was 74.8 ± 6.3 years with a mean initial PSA level of 537.3 ± 999.1 ng/mL. The mean age at alteration to GnRH antagonist was 81.4 years with a mean PSA level of 28.6 ng/mL. Two out of 14 patients (14%) were judged as responders based on PSA after alteration to GnRH antagonist, although they did not show any further reduction of the serum testosterone level (remain less than 0.03). Six patients showed further reduction of the serum FSH level after alteration; however, they showed no PSA response (from 46.4 ± 42.6 to 69.4 ± 70.3). Conclusions: The switch from GnRH agonist to GnRH antagonist affected 14% of the patients (2 out of 14 patients) with CRPC at 3 months based on PSA. Larger and longer-term studies are required to determine the efficacy of alteration to GnRH antagonist in patients with CRPC.
GnRH agonist versus GnRH antagonist in in vitro fertilization and embryo transfer (IVF/ET)
Raffaella Depalo, K Jayakrishnan, Gabriella Garruti, Ilaria Totaro, Mariantonietta Panzarino, Francesco Giorgino, Luigi E Selvaggi
Reproductive Biology and Endocrinology , 2012, DOI: 10.1186/1477-7827-10-26
Involvement of GnRH and Gonadotropin Genes in Oocyte Development of Blue Gourami Females (Trichogaster trichopterus)  [PDF]
Gad Degani
Advances in Biological Chemistry (ABC) , 2014, DOI: 10.4236/abc.2014.43024
Abstract: The goal of this study was to gain a fundamental understanding of RnRH 1 and 3, as well as FSH and LH action, in ovarian follicles during oocyte growth by examining changes in ovarian gene transcription in blue gourami females (Trichogaster trichopterus). The levels of target ovarian mRNAs were determined by quantitative real-time PCR. GnRH1 mRNA levels were higher in oocytes at the previtellogenic stage compared to the vitellogenic and follicular oocytes maturation (FOM) stages. No significant differences in GnRH3 mRNA levels were detected among oocytes during the different stages of development. βLH and βFSH mRNA levels were lower in oocytes at the vitellogenic stage compared to the previtellogenic stage. The high transcription of GnRH 1 and 3 in the brain and of FSH and LH in the pituitary of blue gourami as was found in previous studies in our laboratory, compared to mRNA levels changed in ovary during oogenesis, supporting the hypothesis that differences exist between the function of endocrine and autocrine/paracrine of these hormones.
Comparison of the Predictive Value of Antral Follicle Count, Anti-Müllerian Hormone and Follicle-Stimulating Hormone in Women Following GnRH-Antagonist Protocol for Intracytoplasmic Sperm Injection  [PDF]
Shahinaz H. El-Shorbagy
Open Journal of Obstetrics and Gynecology (OJOG) , 2017, DOI: 10.4236/ojog.2017.74045
Abstract: Background: Prediction of ovarian response is one of the prerequisites for women undergoing intracytoplasmic sperm injection (ICSI) treatment prior to the first controlled ovarian stimulation (COS) cycle. Predictive factors may be variable in patients pre-treated with oral contraceptives (OC) for scheduling purposes. Objective: To evaluate antral follicle count (AFC), anti-müllerian hormone (AMH) and basal follicle stimulating hormone (FSH) for predicting ovarian responses in patients under controlled ovarian hyperstimulation randomized to receive either oral contraceptives (OC) or no treatment (non-OC) prior to their first controlled ovarian stimulation (COS) cycle. Study Design: One hundred infertile women randomized to receive OC treatment or no treatment, prior to their first COS cycle; were stimulated with Gonadotropin Releasing Hormone (GnRH) antagonist protocol. During the early follicular phase (day 2) of the two subsequent cycles (cycle A & cycle B) sonographic (AFC, ovarian volume) and endocrine data (AMH, basal FSH) were recorded. Transvaginal ultrasound was performed for all patients to monitor the ovarian response. Total number of oocytes retrieved and number of generated embryos were recorded and patients were categorized according to retrieved oocytes as poor (oocytes < 5), normal (oocytes 5 - 12) or high responders (oocytes > 12). Result(s): AFC, AMH and basal FSH were lower in users than in non-users of hormonal contraception. Poor responders showed less number of oocytes retrieved and had lower AFC and AMH but a higher basal FSH level was recorded in both groups (OC and non-OC). Conclusion: The better predictive value of AMH or AFC, as a single test or in combination will prevent cycle cancellations due to too low or too high ovarian response. AMH in OC group is not affected by OC pretreatment and is superior to other parameters, while AFC is superior to AMH and basal FSH in non-OC group.
Protocolo largo con análogos de GnRH versus protocolo corto con antagonistas: ?existen diferencias en cuanto a los resultados de los ciclos de FIV-ICSI?
Blasco G,Laura; Armijo S,Onica; Castro M,Bárbara; Lobo M,Sonia; González V,Carolina; Montejo G,Juan Manuel; Cuadrado M,M. Carmen; Fernández M,Beatriz;
Revista chilena de obstetricia y ginecología , 2011, DOI: 10.4067/S0717-75262011000500002
Abstract: aims: to assess if there exist any differences in the results of the ivf-icsi cycles depending on the stimulation protocol employed. methods: retrospective descriptive study of infertile patients who underwent ivf-icsi cycles at la paz university hospital, between january and september 2010, comparing sitmula-tion protocol with gnrh agonists vs antagonists of gnrh. the variables analyzed were pregnancy rate, cancellation rate, total dose of gonadotropin required for stimulation, serum estradiol levels on the day of hcg administration, number of follicles punctured, complexes obtained, number of mature oocytes and of embryos obtained. results: no statistically significant differences where found in the results of cycles depending on the protocol of stimulation used in any of the variables analyzed. conclusions: this study didn't find any difference in the outcome of ivf-icsi cycles in relation to the use of gnrh agonists or antagonists. we need more studies with larger sample sizes to determine which is the best treatment to each patient in order to achieve optimal results.
GnRH antagonist versus agonist in normoresponders undergoing ICSI: a randomized clinical trial in Iran
Ensieh Tehraninejad,Akram Ghahghaei Nezamabadi
Iranian Journal of Reproductive Medicine , 2011,
Abstract: Background: General concern is that the pregnancy rate is higher with GnRH-agonist as a protocol of pituitary suppression. GnRH-antagonist protocol provides a shorter period of administration and an easy flexible protocol.Objective: In this study, the outcomes of GnRH agonist and antagonist in ICSI cycles are compared in normo responder patients.Materials and Methods: In this randomized clinical trial, 300 normoresponders undergoing ICSI were randomly divided to GnRh agonist (n=150) and GnRh antagonist (n=150) groups. The main outcome measurements were chemical, clinical and ongoing pregnancy rates (PR).Results: The mean duration of stimulation were 9.6±1.6 and 8.2±1.6 days in agonist and antagonist groups respectively (p=0.001). The mean number of MII oocyte retrieved in agonist and antagonist groups were 7.7±4.0 and 6.9±4.3 respectively (p=0.03). There was no significant difference between two groups regarding mean number of gonadotrophin ampoules, follicles, occytes, total embryos and good quality embryos, OHSS incidence, and abortion rate. Chemical pregnancy rate was 35.3% in agonist and 39.3% in antagonist group. Clinical pregnancy rate was 35.3% in agonist and 34% in antagonist group. Ongoing pregnancy rate was 45 (31.3%) in agonist and 44 (29.3%) in antagonist group. There was no significant difference between two groups in pregnancy rates.Conclusion: In this study antagonist protocol was shown to be an easy, safe and friendly protocol in Iranian normoresponder patients, having similar outcomes with standard agonist protocol but shorter period of stimulation
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