Abstract
Objectives
In the long gonadotropin-releasing hormone agonist (GnRHa) protocols, stimulation
is delayed until complete pituitary–ovarian suppression has been achieved, which usually
takes a minimum of 10 days. In women who do not achieve timely suppression we set
out to evaluate if prolonging GnRHa affects the results of the IVF process.
Study design
We analyzed cycle and pregnancy outcome in 506 consecutive women undergoing IVF-ET
after a standardized long GnRHa protocol, according to the time required to achieve
ovarian suppression (i.e. estradiol < 40 pg/mL and no follicle >6 mm at ultrasound).
Results
Suppression was obtained after 14 GnRHa days in 383 (75.70%) women (Group 1) and 123
(24.30%) women (Group 2) required a mean ± SD (range) of 10 ± 4 (7–28) additional days to achieve complete suppression. Both groups were comparable
for baseline clinical and biological characteristics. The rate of cancelled cycles
due to poor ovarian response, the number of the oocytes retrieved, fertilization rates,
the number and quality of the embryos cultured and transferred were similar in both
groups, as well as the pregnancy, implantation and live birth rates. In Group 2, receiver–operator
characteristics analysis showed that the probability of pregnancy was not related
to the duration of GnRHa treatment.
Conclusions
In a standardized long GnRHa protocol, prolonging desensitization to achieve complete
ovarian suppression does not affect the outcome.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to European Journal of Obstetrics and Gynecology and Reproductive BiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The science behind 25 years of ovarian stimulation for in vitro fertilization.Endocr Rev. 2006; 27: 170-207
- The routine use of gonadotropin releasing hormone agonists prior to in vitro fertilization and gamete intra fallopian transfer: a meta-analysis of randomized studies.Fertil Steril. 1992; 58: 888-896
- Early pituitary desensitization and ovarian suppression with leuprolide acetate is associated with in vitro fertilization embryo transfer success.Fertil Steril. 1991; 56: 500-504
- Aberrant estradiol flare despite gonadotropin-releasing-hormone-agonist-induced-suppression is associated with impaired implantation.Fertil Steril. 1994; 61: 558-560
- A cycle-based model to predict blastocyst transfer cancellation.Hum Reprod. 2010; 25: 598-604
- GnRH antagonists in ovarian stimulation for IVF.Hum Reprod Update. 2006; 12: 333-340
- Are GnRH antagonists comparable to agonists for use in IVF?.Hum Reprod. 2007; 22: 2805-2813
- No detrimental effects in delaying initiation of gonadotropin administration after pituitary desensitization with gonadotropin-releasing hormone agonist.Fertil Steril. 1993; 59: 183-186
- The duration of leuprolide acetate administration prior to ovulation induction does not impact ovarian responsiveness to exogenous gonadotropins.Fertil Steril. 1993; 60: 247-253
- Delay of gonadotropin stimulation in patients receiving gonadotropin-releasing hormone agonist (GnRH-a) therapy permits increased clinic efficiency and may enhance in vitro fertilization (IVF) pregnancy rates.Fertil Steril. 1997; 68: 1004-1010
- Significance of an abnormal response during pituitary desensitization in an in vitro fertilization and embryo transfer program.J Assist Reprod Genet. 1996; 13: 374-380
- The effect of the duration of GnRH agonist before ovarian stimulation on the biological and clinical outcome after intracytoplasmic sperm injection.Eur J Obstet Gynecol Reprod Biol. 1998; 80: 251-255
- Pituitary down-regulation in IVF cycles: is it necessary to use strict criteria?.J Assist Reprod Genet. 1995; 12: 615-619
Article info
Publication history
Published online: June 27, 2011
Accepted:
June 9,
2011
Received in revised form:
April 3,
2011
Received:
October 29,
2010
Identification
Copyright
© 2011 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
