DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20150062

A comparative study between agonist and antagonist protocol for ovarian stimulation in art cycles at a rural set up in South Gujarat

Purnima Kishor Nadkarni, Kishore Mohan Nadkarni, Kanika Rajendra Kalyani

Abstract


Background: Modern infertility practice provides us with several protocols for controlled ovarian hyperstimulation for the ART (Assisted Reproductive Techniques) cycles. The review summarises the clinical characteristics of the protocols using Gonadotrophin Releasing Hormone (GnRH) agonists and antagonists emphasising on the major clinical and laboratory outcomes with each protocol.

Methods: A total of 322 cases undergoing ovarian stimulation with agonist and antagonist protocols in ART cycles at a rural set up at Killa Pardi in the year 2014 were studied and their laboratory and clinical outcomes were evaluated.

Results: Antagonist group had the maximum number of oocytes retrieved and the mature M2 oocytes, maximum No. of follicles >16 mm on day of HCG, maximum No. of positive pregnancy rates. Agonist group had also a good pregnancy rate with maximum Grade I embryos.

Conclusions: Taking all data together, it may be concluded that antagonists and minimal ovarian stimulation with antagonist protocols offer a new treatment regimen in ovarian stimulation that is short, safe, cost effective, well tolerated, optimizing convenience for the patient.


Keywords


GnRH agonist protocol, Antagonist protocol, Ovarian stimulation

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References


Depalo R, Jayakrishan K, Garruti G, Totaro I, Panzarino M, Giorgino F, et al. GnRH agonist versus GnRH antagonist in invitro fertilization and embryo transfer (IVF/ET). Reprod Biol Endocrinol. 2012;10:26.

Caspi E, Ron-El R, Golan, Nachum H, Herman A, Soffer Y, et al. Results of in vitro fertilisation and embryo transfer by combined long acting gonadotropin releasing hormone analog D-Trp-6-luteinizing hormone releasing hormone and gonadotropins. Fertil Steril. 1989;51(1):95-9.

Liu HC, Lai YM, Davis O, Berkeley AS, Graf M, Grifo J, et al. Improved pregnancy outcome with gonadotropin releasing hormone agonist (GnRH-a) stimulation is due to the improvement in oocyte quantity rather than quality. J Assist Reprod Genet. 1992;9(4):338-44.

Conn PM, Staley D, Harris C, Andrews WV, Gorospe WC, McArdle CA. Mechanism of action of gonadotropin releasing hormone. Annu Rev Physiol. 1986;48:495-513.

Rizk B, Smith J. Ovarian hyperstimulation syndrome after superovulation using GnRH agonists for IVF and related procedures. Hum Reprod. 1992;7(3):320-7.

Ben-Rafael Z, Lipitz S, Bider D, Mashiach S. Ovarian hyporesponsiveness in combined gonadotropin-releasing hormone agonist and menotropin therapy is associated with low serum follicle stimulating hormone levels. Fertil Steril. 1991;55(2):272-5.

Ron-El R, Herman A, Golan A, Raziel A, Soffer Y, Caspi E. Follicle cyst formation following long acting gonadotropin releasing hormone analog administration. Fertil Steril. 1989;52(6):1063-6.

Olivennes F, Frydman R. Friendly IVF: the way of the future. Human Reprod. 1998;13(5):1121-4.

Ludwig M, Katalinic A, Banz C, Schroder AK, Lonong M, Weiss JM, et al. Tailoring the GnRH antagonist cetrorelix acetate to individual patients’ needs in ovarian stimulation for IVF and results of the perspective. Fertil Steril. 2000;73(2):314-20.

Prapas Y, Pettousis S, Dagklis T, Panagiotidis Y, Papatheodorou A, Assunta I, et al. GnRH antagonist versus long GnRH agonist protocol in poor IVF responders: a randomized clinical trial. Eur J Obstet Gynecol Reprod Biol. 2013;166:43-6.

Kim CH, You RM, Kang HJ, Ahn JW, Jeon I, Lee JW, et al. GnRH antagonist multiple dose protocol with oral contraceptive pill pretreatment in poor responders undergoing IVF/ICSI. Clin Exp Reprod Med. 2011;38:228-33.

Andersen AN, Witjes H, Gordon K, Mannaerts B. Predictive factors of ovarian response and clinical outcome after IVF/ICSI following a rFSH/GnRH antagonist protocol with or without oral contraceptive pre-treatment. Hum Reprod. 2011;26:3413-23.