Volume 16, Issue 3 (3-2018)                   IJRM 2018, 16(3): 175-182 | Back to browse issues page

XML Persian Abstract Print

Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:

Depalo R, Trerotoli P, Chincoli A, Vacca M P, Lamanna G, Cicinelli E. Endogenous luteinizing hormone concentration and IVF outcome during ovarian stimulation in fixed versus flexible GnRH antagonist protocols: An RCT. IJRM. 2018; 16 (3) :175-182
URL: http://journals.ssu.ac.ir/ijrmnew/article-1-1029-en.html
1- Department of Obstetrics-Gynecology-Neonatology and Anesthesiology, Unit of Medically Assisted Reproduction and Gametes Cryopreservation, University Hospital of Bari, Bari, Italy.
2- Department of Biomedical and Human Oncological Science (DIMO), 2nd Unit of Obstetrics and Gynecology, University of Bari, Bari, Italy
3- Department of Obstetrics-Gynecology-Neonatology and Anesthesiology, Unit of Medically Assisted Reproduction and Gametes Cryopreservation, University Hospital of Bari, Bari, Italy , annarosa.chincoli@virgilio.it
4- Department of Obstetrics-Gynecology-Neonatology and Anesthesiology, Unit of Medically Assisted Reproduction and Gametes Cryopreservation, University Hospital of Bari, Bari, Italy
5- Consultant Gynaecologist and IVF Specialist, London Women's Clinic, London, UK
Abstract:   (313 Views)
Background: Luteinizing hormone (LH) is essential for normal follicular development and oocyte maturation. In particular, fluctuations of LH during the follicular phase have a significant impact on morphological and functional changes of the oocyte and determine its meiotic status and ability to be fertilized.
Objective: This prospective randomized controlled trial examined effects of endogenous follicular phase LH levels on oocyte maturity and IVF outcomes in fixed vs. flexible in vitro fertilization.
Materials and Methods: Normo-ovulatory women age <39 yr (n=213) were randomized to fixed or flexible gonadotrophin-releasing hormone (GnRH) antagonist protocols. Follicular phase LH, estradiol, and progesterone profiles were measured. Oocytes retrieved, implantation rate, and pregnancy rate were compared between the two groups.
Results: LH profiles were similar in both protocols. A lower trend of LH values at the end of ovarian stimulation correlated significantly with a higher pregnancy rate, regardless of protocol (p=0.02). Estradiol levels were statistically different with respect to time points within treatment groups (p<0.0001), but not between groups (p=0.43), or pregnancy outcomes (p=0.2595). Progesterone profiles were similar between groups. No differences were found in retrieved oocytes numbers, fertilization rate or embryos obtained. Significantly, younger age and a higher number of antral follicles were correlated with positive results.
Conclusion: Fixed and flexible GnRH antagonist protocols did not produce an oscillation of endogenous LH values correlated to the outcome of ovarian stimulation.
Full-Text [PDF 467 kb]   (183 Downloads) |   |   Full-Text (HTML)  (23 Views)  
Type of Study: Original Article |
Received: 2018/04/12 | Accepted: 2018/04/12 | Published: 2018/04/12

1. Raju GA, Chavan R, Deenadayal M, Gunasheela D, Gutgutia R, Haripriya G, et al. Luteinizing hormone and follicle stimulating hormone synergy: A review of role in controlled ovarian hyper-stimulation. J Hum Reprod Sci 2013; 6: 227-234. [DOI:10.4103/0974-1208.126285]
2. Huirne JA, van Loenen AC, Schats R, McDonnell J, Hompes PG, Schoemaker J, et al. Dose-finding study of daily GnRH antagonist for the prevention of premature LH surges in IVF/ICSI patients: optimal changes in LH and progesterone for clinical pregnancy. Hum Reprod 2005, 20: 359-367. [DOI:10.1093/humrep/deh601]
3. Ganirelix Dose-finding Study Group. A double-blind, randomized, dose finding study to assess the efficacy of the gonadotrophin-releasing hormone antagonist ganirelix (Org 37462) to prevent premature luteinizing hormone surges in women undergoing ovarian stimulation with recombinant follicle stimulating hormone (Puregon). The ganirelix dose-finding study group. Hum Reprod 1998; 13: 3023-3031. [DOI:10.1093/humrep/13.11.3023]
4. Copperman AB, Benadiva C. Optimal usage of the GnRH antagonists: a review of the literature. Reprod Bio Endocrinol 2013, 11: 20. [DOI:10.1186/1477-7827-11-20]
5. Depalo R, Jayakrishan K, Garruti G, Totaro I, Panzarino M, Giorgino F, et al. GnRH agonist versus GnRH antagonist in in vitro fertilization and embryo transfer (IVF/ET). Reprod Biol Endocrinol 2012, 10: 26. [DOI:10.1186/1477-7827-10-26]
6. Kolibianakis EM, Albano C, Kahn J, Camus M, Tournaye H, Van Steirteghem AC, et al. Exposure to high levels of luteinizing hormone and estradiol in the early follicular phase of gonadotropin-releasing hormone antagonist cycles is associated with a reduced chance of pregnancy. Fertil Steril 2003, 79: 873-880. [DOI:10.1016/S0015-0282(02)04920-8]
7. Bosch E, Escudero E, Crespo J, Simón C, Remohí J, Pellicer A. Serum luteinizing hormone in patients undergoing ovarian stimulation with gonadotropin-releasing hormone antagonists and recombinant follicle-stimulating hormone and its relationship with cycle outcome. Fertil Steril 2005, 84: 1529-1532. [DOI:10.1016/j.fertnstert.2005.05.040]
8. Sönmezer M, Pelin Cil A, Atabekoğlu C, Ozkavukçu S, Ozmen B. Does premature luteinization or early surge of LH impair cycle outcome? Report of two successful outcomes. J Assist Reprod Genet 2009; 26: 159-163. [DOI:10.1007/s10815-009-9299-5]
9. Depalo R, Garruti G, Totaro I, Panzarino M, Vacca MP, Giorgino F, et al. Oocyte morphological abnormalities in overweight women undergoing in vitro fertilization cycles. Gynecol Endocrinol 2011; 27: 880-884. [DOI:10.3109/09513590.2011.569600]
10. Kolibianakis EM, Zikopoulos K, Schiettecatte J, Smitz J, Tournaye H, Camus M, et al. Profound LH suppression after GnRH antagonist administration is associated with a significantly higher ongoing pregnancy rate in IVF. Hum Reprod 2004, 19: 2490-2496. [DOI:10.1093/humrep/deh471]
11. Lainas T, Zorzovilis J, Petsas G, Stavropoulou G, Cazlaris H, Daskalaki V, et al. In a flexible antagonist protocol, earlier, criteria-based initiation of GnRH antagonist is associated with increased pregnancy rates in IVF. Hum Reprod 2005, 20: 2426-2433. [DOI:10.1093/humrep/dei106]
12. Kolibianakis EM, Albano C, Camus M, Tournaye H, Van Steirteghem AC, Devroey P. Initiation of gonadotropin-releasing hormone antagonist on day 1 as compared to day 6 of stimulation: effect on hormonal levels and follicular development in in vitro fertilization cycles. J Clin Endocrinol Metab 2003; 88: 5632-5637. [DOI:10.1210/jc.2003-030805]
13. Merviel P, Antoine JM, Mathieu E, Millot F, Mandelbaum J, Uzan S. Luteinizing hormone concentrations after gonadotropin-releasing hormone antagonist administration do not influence pregnancy rates in in vitro fertilization-embryo transfer. Fertil Steril 2004, 82: 119-125. [DOI:10.1016/j.fertnstert.2003.11.040]
14. Griesinger G, Shapiro DB, Kolibianakis EM, Witjes H, Mannaerts BM. No association between endogenous LH and pregnancy in a GnRH antagonist protocol: part II, recombinant FSH. Reprod Biomed Online 2011, 23: 457-465. [DOI:10.1016/j.rbmo.2011.06.016]
15. Al-Inany H, Aboulghar MA, Mansour RT, Serour GI. Optimizing GnRH antagonist administration: meta-analysis of fixed versus flexible protocol. Reprod Biomed Online 2005, 10: 567-570. [DOI:10.1016/S1472-6483(10)61661-6]
16. Hamdine O, Broekmans FJ, Eijkemans MJ, Lambalk CB, Fauser BC, Laven JS, et al. Early initiation of gonadotropin-releasing hormone antagonist treatment results in a more stable endocrine milieu during the mid- and late-follicular phases: a randomized controlled trial comparing gonadotropin-releasing hormone antagonist initiation on cycle day 2 or 6. Fertil Steril 2013; 100: 867-874. [DOI:10.1016/j.fertnstert.2013.05.031]
17. La Marca A, Grisendi V, Giulini S, Argento C, Tirelli A, Dondi G, et al. Individualization of the FSH starting dose in IVF/ICSI cycles using the antral follicle count. J Ovarian Res 2013, 6: 11. [DOI:10.1186/1757-2215-6-11]
18. Papanikolaou EG, Pados G, Grimbizis G, Bili E, Kyriazi L, Polyzos NP, et al. GnRH-agonist versus GnRH-antagonist IVF cycles: is the reproductive outcome affected by the incidence of progesterone elevation on the day of HCG triggering? A randomized prospective study. Hum Reprod 2012; 27: 1822-1828. [DOI:10.1093/humrep/des066]
19. Griesinger G, Mannaerts B, Andersen CY, Witjes H, Kolibianakis EM, Gordon K. Progesterone elevation does not compromise pregnancy rates in high responders a pooled analysis of in vitro fertilization patients treated with recombinant follicle-stimulating hormone/gonadotropin-releasing hormone antagonist in six trials. Fertil Steril 2013, 100: 1622-1628. [DOI:10.1016/j.fertnstert.2013.08.045]
20. Detti L, Yelian FD, Kruger ML, Diamond MP, Rode A, Mitwally MF, et al. Endometrial thickness is related to miscarriage rate, but not to the estradiol concentration, in cycles down-regulated with gonadotropin-releasing hormone antagonist. Fertil Steril 2008; 89: 998-1001. [DOI:10.1016/j.fertnstert.2007.04.027]
21. Huirne JA, Homburg R, Lambalk CB. Are GnRH antagonists comparable to agonists for use in IVF? Hum Reprod 2007; 22: 2805-2813. [DOI:10.1093/humrep/dem270]

Add your comments about this article : Your username or Email:

Send email to the article author

© 2019 All Rights Reserved | International Journal of Reproductive BioMedicine

Designed & Developed by : Yektaweb