Volume 6, Issue 2 (7-2008)                   IJRM 2008, 6(2): 33-0 | Back to browse issues page

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Shahrokh Tehrani nejad E, Attar Shakeri B, Hoseini Rashidi B, Ramezanzade F, Shariat M. GnRHa stop protocol versus long protocol in poor responder IVF patients. IJRM. 2008; 6 (2) :33-0
URL: http://journals.ssu.ac.ir/ijrmnew/article-1-99-en.html
1- Vali-e-Asr Reproductive Health Research Center (V.R.H.R.C), Tehran University of Medical Sciences (T.U.M.S), Vali-e-Asr Hospital, Imam Khomeini Hospital, Tehran, Iran
2- Vali-e-Asr Reproductive Health Research Center (V.R.H.R.C), Tehran University of Medical Sciences (T.U.M.S), Vali-e-Asr Hospital, Imam Khomeini Hospital, Tehran, Iran , be_shakeri@yahoo.com
Abstract:   (1467 Views)
Background: Recently different studies suggested that discontinuation of gonadotrophin releasing hormone analogue (GnRHa) at beginning of ovarian stimulation (improvement of ovarian response to gonadotrophins) may have some benefit to poor responder patients in invitro fertilization (IVF) cycles. Objective:The efficacy of GnRHa stop protocol in poor responder patients in IVF cycles was assessed.
Materials and Methods: This study was a prospective, randomized controlled trial that 40 poor responder patients (less than three mature follicles in a previous cycle) with normal basal follicle stimulating hormone (FSH) were randomly allocated into two protocols: 1) Non-stop protocol: long GnRHa suppression, and start gonadotrophins from day 3 of mense. 2) Stop-protocol: GnRHa is stopped with the onset of menses, and gonadotrophin doses remained similar to group 1.
Results: A significantly higher number of follicles, oocytes, embryos and fertilization rate also shorter stimulation days and lower human menopausal gonadotropins (HMG) ampoules were recorded in the stop protocol compared to the control group. Both protocols resulted in a similar cancellation rate, pregnancy rate, estradiol level and LH level.
Conclusion: Early follicular cessation of GnRHa permitted the retrieval of a significantly higher number of follicles, oocytes and embryos, and can reduce the number of HMG and stimulation days.
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Type of Study: Original Article |

1. Tarlatzis BC, Zepiridis L, Grimbizis G, Bontis J. Clinical management of low ovarian response to stimulation for IVF. Hum Reprod Update 2003; 9: 61-76. [DOI:10.1093/humupd/dmg007]
2. Garcia JE, Jones GS, Acosta AA, Wright GJr. Human menopausal gonadotropin/human chorionic gonadotropin follicular maturation for oocyte aspiration. Fertil Steril 1983; 39(2): 174-179. [DOI:10.1016/S0015-0282(16)46815-9]
3. Keay SD, Liversedge NH, Mathur RS, Jenkins JM. Assisted conception following poor ovarian response to gonadotrophin stimulation. Br J Obstet Gynaecol 1997; 104: 521-527. [DOI:10.1111/j.1471-0528.1997.tb11525.x]
4. Scott RT Jr. Evaluation and treatment of low responders. Semin Reprod Endocrinol 1996; 14: 317-337 [DOI:10.1055/s-2008-1067977]
5. Karande V, Gleicher N. A rational approach to the management of low responders in in-vitro fertilization. Hum Reprod 1999; 14: 1744-1748. [DOI:10.1093/humrep/14.7.1744]
6. Faber BM, Mayer J, Cox B, Jones D, Toner JP, Oehninger S, et al. Cessation of gonadotrophin-releasing hormone agonist therapy combined with high-dose gonadotrophin stimulation yields favorable pregnancy results in low responders. Fertil Steril 1998; 69: 826-830. [DOI:10.1016/S0015-0282(98)00040-5]
7. Dirnfield M, Fruchter O, Yshai D. Cessation of gonadotrophin-releasing hormone analogue (GnRH-a) upon down-regulation versus conventional long GnRH-a protocol in poor responders undergoing in vitro fertilization. Fertil Steril 1999; 72: 406-411. [DOI:10.1016/S0015-0282(99)00289-7]
8. Detti L, Williams DB, Robins JC, Maxwell RA, Thomas MA. Comparison of three downregulation approaches for poor responders undergoing in vitro fertilization, Fertil Steril 2005; 84(5): 1401-1405. [DOI:10.1016/j.fertnstert.2005.04.053]
9. Beckers NGM, Laven JSE, Eijkemans MJC. Follicular and luteal phase characteristics following early cessation of gonadotrophin-releasing hormone agonist during ovarian stimulation for in-vitro fertilization. Hum Reprod 2000; 15: 43-49. [DOI:10.1093/humrep/15.1.43]
10. Garcia-Velasco JA, Isaza V, Requena A, Martínez-Salazar FJ, Landazábal A, Remohí J, et al. High doses of gonadotrophins combined with stop versus non-stop protocol of GnRH analogue administration in low responder IVF patients: a prospective, randomized, controlled trial. Hum Reprod 2000; 15: 2292-2296. [DOI:10.1093/humrep/15.11.2292]
11. Gil-Salom M, Mínguez Y, Rubio C, De los Santos MJ, Remohí J, Pellicer A. Efficacy of intracytoplasmic sperm injection using testicular spermatozoa. Hum Reprod 1995; 10: 3166-3170. [DOI:10.1093/oxfordjournals.humrep.a135880]
12. Sungurtekin U, Jansen RPS. Profound Latinizing hormone suppression after stopping the gonadotrophin releasing hormone-agonist leuprolide acetate. Fertil Steril 1995; 63: 663-665. [DOI:10.1016/S0015-0282(16)57443-3]
13. Horvath PM, Styler M, Hammond JM, Shelden RM, Kemmann E. Exogenous gonadotropin requirements are increased in leuprolide suppressed women undergoing ovarian stimulation. Fertil Steril 1988; 49: 159-162. [DOI:10.1016/S0015-0282(16)59669-1]
14. Kowalik A, Barmat L, Damario M, Liu HC, Davis O, Rosenwaks Z. Ovarian estradiol production in vivo. Inhibitory effect of leuprolide acetate. J Reprod Med 1998; 43: 413-417.
15. Latouche J, Crumeyrolle-Arias M, Jordan D, Kopp N, Augendre-Ferrante B, Cedard L, et al. GnRH receptors in human granulosa cells: anatomical localization and characterization by autoradiographic study. Endocrinology 1989; 125: 1739-1741. [DOI:10.1210/endo-125-3-1739]
16. Aleem, FA, Predanic M. The hemodynamic effect of GnRH agonist therapy on uterine leiomyoma vascularity: a prospective study using transvaginal color Doppler sonography. Gynecol Endocrinol 1995; 9: 253-528. [DOI:10.3109/09513599509160454]
17. Zeleznik AJ, Schuler HM, Reichert LEJ. Gonadotrophin-binding sites in the Rhesus monkey ovary: role of the vasculature in the selective distribution of human chorionic gonadotrophin to the preovulatory follicle. Endocrinology 1981; 109: 356-362. [DOI:10.1210/endo-109-2-356]
18. Engmann L, Sladkevicius P, Agrawal R, Bekir JS, Campbell S, Tan SL. Value of ovarian stromal blood flow velocity measurement after pituitary suppression in the prediction of ovarian responsiveness and outcome of in vitro fertilization treatment. Fertil Steril 1999; 71: 22-29. [DOI:10.1016/S0015-0282(98)00406-3]
19. Bhal PS, Pugh ND, Chui DK, Gregory L, Walker SM, Shaw RW. The use of transvaginal power Doppler ultrasonography to evaluate the relationship between perifollicular vascularity and outcome in in-vitro fertilization treatment cycles. Hum Reprod 1999; 14: 939-945. [DOI:10.1093/humrep/14.4.939]
20. Lashen H, Ledger W, Lopez-Bernal A, Barlow D. Poor responders to ovulation induction: is proceeding to in-vitro fertilization worthwhile? Hum Reprod 1999; 14: 964-969. [DOI:10.1093/humrep/14.4.964]
21. Schachter M, Friedler S, Raziel A, Strassburger D, Bern O, Ron-el R. Improvement of IVF outcome in poor responders by discontinuation of GnRH analogue during the gonadotropin stimulation phase--a function of improved embryo quality. J Assist Reprod Genet 2001; 18: 197-204. [DOI:10.1023/A:1009476411762]

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