Research Article
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Effect of long GnRH Agonist, GnRH Antagonist and Microdose Flare-up Agonist protocols on IVF results in patients with diminished ovarian reserve

Year 2019, Volume: 9 Issue: 3, 140 - 145, 16.09.2019

Abstract

Objective: To compare the effect of gonadotropin-releasing hormone (GnRH) antagonist protocol,
microdose flare-up protocol and long GnRH agonist protocol in patients receiving in vitro fertilization/
intracytıplasmic sperm injection (IVF/ICSI)treatment due to poor response .
Materials and methods: In a retrospective study, the records of patients who were poor responders
attending University of Health Sciences Ankara Etlik Zübeyde Hanım Womens Health Application and
Research Center, IVF Clinic between January , 2010 and May, 2019 were retrieved. Overall 713 patients
were divided into 3 groups: Group A(n=327) gonadotropin-releasing hormone (GnRH) antagonist protocol,
Group B(n=184) long GNRH analog protocol, Group C( n=202) microdose flare-up protocol. The ovarian
stimulation characteristics as well as the clinical pregnancy rates were compared between groups.
Results: Seven hundred and thirteen patients included in the study.Treatment duration and number of
mature oocytes were significantly higher in women undergoing the long GnRH agonist regimen compared
with Group A and Group C(p=0.001 for both). The cycle cancellation rate and total gonadotropin dose were
significantly higher in group C (p=0.001). A significant difference was not observed with respect to the
number of retrieved oocytes . No statistically significant differences were detected in clinical pregnancy
rates between the groups (p=0.337).
Conclusion: GnRH antagonist regimen may be preferable to other protocols as it could decrease the cost
and treatment duration in poor responders

References

  • 1. Keay SD, Liversedge NH, Mathur RS, Jenkins JM. Assisted conception following poor ovarian response to gonadotrophin stimulation. Br J Obstet Gynaecol 1997;104:521-7. 2. Şahin S, Selçuk S, Devranoğlu B, Kutlu T, Kuyucu M, Eroğlu M. Comparison of long GnRH agonist versus GnRH antagonist protocol in poor responders. J Turk Soc Obstet Gynecol 2014;4:203-6 3. Ferraretti AP, La Marca A, Fauser JM, Tarlatzis B, Nargund G,Gianaroli L. ESHRE consensus on the definition of ‘poor response’ to ovarian stimulation for in vitro fertilization: the Bologna criteria. Hum Reprod 2011;.26( 7): 1616– 1624 4. Humaidan P , Alviggi C, Fischer R, Esteves SC. The novel POSEIDON stratification of ‘Low prognosis patients in Assisted Reproductive Technology’ and its proposed marker of successful outcome. F1000Research 2016, 5:2911 5. Cohen J, Chabbert-Buffet N, Darai E. Diminished ovarian reserve, premature ovarian failure, poor ovarian responder—a plea for universal definitions. J Assist Reprod Genet 2015; 32: 1709–171 6. Lambalk CB, Banga1 FR, Huirne JA, Toftager M, Pinborg A, Homburg R et al. GnRH antagonist versus long agonist protocols in IVF: a systematic review and meta-analysis accounting for patient type. Hum Reprod Update 2017; 23(5) :560–579 7. Berin I, Stein DE, Keltz MD. A comparison of gonadotropin-releasing hormone (GnRH) antagonist and GnRH agonist flare protocols for poor responders undergoing in vitro fertilization. Fertil Steril 2010;93:360–3. 8. Kahraman K, Berker B, Atabekoglu CS, Sonmezer M, Cetinkaya E, Aytac R et al. Microdose gonadotropin-releasing hormone agonist flare-up protocol versus multiple dose gonadotropin-releasing hormone antagonist protocol in poor responders undergoing intracytoplasmic sperm injection–embryo transfer cycle. Fertil Steril 2009;91:2437–44. 9.Prapas Y, Petousis S, Dagklis T, PanagiotidisY, 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 and Reprod Biol 2013;166: 43–46 10. Merviel P, Cabry-Goubet R, Lourdel E, Devaux A, Belhadri-Mansouri N, Copin H et al. Comparative prospective study of 2 ovarian stimulation protocols in poor responders: effect on implantation rate and ongoing pregnancy. Reprod Health 2015; 12:52

AZALMIŞ OVER RESERVİ OLAN OLGULARDA LONG GNRH AGONİST, GNRH ANTAGONİST VE MİKRODOZ FLARE-UP AGONİST PROTOKOLLERİNİN IVF SONUÇLARI ÜZERİNE ETKİSİ

Year 2019, Volume: 9 Issue: 3, 140 - 145, 16.09.2019

Abstract

Amaç: Düşük over rezervi tanısıyla IVF programına alınan hastalarda uygulanan mikro doz flare up , GnRH
antagonist ve long GnRH agonist gibi farklı protokollerin IVF başarısındaki etkinliğinin karşılaştırılması.
Gereç ve yöntemler: Sağlık Bilimleri Üniversitesi Ankara Etlik Zübeyde Hanım Eğitim ve Araştırma Hastanesi
IVF Kliniğine Ocak 2010 ve Mayıs 2019 tarihleri arasında başvuran ve düşük over reservi tanısı alan hastalar
çalışmaya dahil edildi. 713 kadın kullanılan kontrollü ovarian stimulasyon protokellerine göre 3 gruba ayrıldı:
Grup A(n=327) GnRH antagonist protokol, Grup B(n=184), long GnRH agonist protokol ve Grup C (n=202)
mikrodoz flare-up protokol olarak belirlendi. Gruplar arasında ovarian stimulasyon karekteristikleri ve klinik
gebelik sonuçları karşılaştırıldı.
Bulgular:713 olgu çalışmaya dahil edildi. Long GnRH agonist protokol grubu, Grup A ve Grup C ile karşılaştırıldığında stimulasyon süresi anlamlı olarak daha uzun ve matur oosit sayısı daha fazla bulundu(p=0.001).
Total gonadotropin dozu ve siklus iptal oranları grup C de anlamlı olarak yüksekti(p=0.001).Gruplar arasında
toplanan oosit sayısı açısından anlamlı fark bulunmadı. Klinik gebelik oranları bakımından gruplar arasında
anlamlı fark tespit edilmedi(p=0.337).
Sonuç: Düşük over reservi olan kadınlarda tedavi süresini ve maliyeti azaltması nedeniyle , GnRH antagonist
protokolü ilk tedavi seçeneği olarak düşünülebilir. 

References

  • 1. Keay SD, Liversedge NH, Mathur RS, Jenkins JM. Assisted conception following poor ovarian response to gonadotrophin stimulation. Br J Obstet Gynaecol 1997;104:521-7. 2. Şahin S, Selçuk S, Devranoğlu B, Kutlu T, Kuyucu M, Eroğlu M. Comparison of long GnRH agonist versus GnRH antagonist protocol in poor responders. J Turk Soc Obstet Gynecol 2014;4:203-6 3. Ferraretti AP, La Marca A, Fauser JM, Tarlatzis B, Nargund G,Gianaroli L. ESHRE consensus on the definition of ‘poor response’ to ovarian stimulation for in vitro fertilization: the Bologna criteria. Hum Reprod 2011;.26( 7): 1616– 1624 4. Humaidan P , Alviggi C, Fischer R, Esteves SC. The novel POSEIDON stratification of ‘Low prognosis patients in Assisted Reproductive Technology’ and its proposed marker of successful outcome. F1000Research 2016, 5:2911 5. Cohen J, Chabbert-Buffet N, Darai E. Diminished ovarian reserve, premature ovarian failure, poor ovarian responder—a plea for universal definitions. J Assist Reprod Genet 2015; 32: 1709–171 6. Lambalk CB, Banga1 FR, Huirne JA, Toftager M, Pinborg A, Homburg R et al. GnRH antagonist versus long agonist protocols in IVF: a systematic review and meta-analysis accounting for patient type. Hum Reprod Update 2017; 23(5) :560–579 7. Berin I, Stein DE, Keltz MD. A comparison of gonadotropin-releasing hormone (GnRH) antagonist and GnRH agonist flare protocols for poor responders undergoing in vitro fertilization. Fertil Steril 2010;93:360–3. 8. Kahraman K, Berker B, Atabekoglu CS, Sonmezer M, Cetinkaya E, Aytac R et al. Microdose gonadotropin-releasing hormone agonist flare-up protocol versus multiple dose gonadotropin-releasing hormone antagonist protocol in poor responders undergoing intracytoplasmic sperm injection–embryo transfer cycle. Fertil Steril 2009;91:2437–44. 9.Prapas Y, Petousis S, Dagklis T, PanagiotidisY, 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 and Reprod Biol 2013;166: 43–46 10. Merviel P, Cabry-Goubet R, Lourdel E, Devaux A, Belhadri-Mansouri N, Copin H et al. Comparative prospective study of 2 ovarian stimulation protocols in poor responders: effect on implantation rate and ongoing pregnancy. Reprod Health 2015; 12:52
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Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Original Research
Authors

Runa Özelçi

Oya Aldemir This is me

Nefise Nazlı Yenigül This is me

Serdar Dilbaz This is me

Özlem Moraloğlu Tekin This is me

Publication Date September 16, 2019
Published in Issue Year 2019 Volume: 9 Issue: 3

Cite

APA Özelçi, R., Aldemir, O., Yenigül, N. N., Dilbaz, S., et al. (2019). AZALMIŞ OVER RESERVİ OLAN OLGULARDA LONG GNRH AGONİST, GNRH ANTAGONİST VE MİKRODOZ FLARE-UP AGONİST PROTOKOLLERİNİN IVF SONUÇLARI ÜZERİNE ETKİSİ. Bozok Tıp Dergisi, 9(3), 140-145.
AMA Özelçi R, Aldemir O, Yenigül NN, Dilbaz S, Moraloğlu Tekin Ö. AZALMIŞ OVER RESERVİ OLAN OLGULARDA LONG GNRH AGONİST, GNRH ANTAGONİST VE MİKRODOZ FLARE-UP AGONİST PROTOKOLLERİNİN IVF SONUÇLARI ÜZERİNE ETKİSİ. Bozok Tıp Dergisi. September 2019;9(3):140-145.
Chicago Özelçi, Runa, Oya Aldemir, Nefise Nazlı Yenigül, Serdar Dilbaz, and Özlem Moraloğlu Tekin. “AZALMIŞ OVER RESERVİ OLAN OLGULARDA LONG GNRH AGONİST, GNRH ANTAGONİST VE MİKRODOZ FLARE-UP AGONİST PROTOKOLLERİNİN IVF SONUÇLARI ÜZERİNE ETKİSİ”. Bozok Tıp Dergisi 9, no. 3 (September 2019): 140-45.
EndNote Özelçi R, Aldemir O, Yenigül NN, Dilbaz S, Moraloğlu Tekin Ö (September 1, 2019) AZALMIŞ OVER RESERVİ OLAN OLGULARDA LONG GNRH AGONİST, GNRH ANTAGONİST VE MİKRODOZ FLARE-UP AGONİST PROTOKOLLERİNİN IVF SONUÇLARI ÜZERİNE ETKİSİ. Bozok Tıp Dergisi 9 3 140–145.
IEEE R. Özelçi, O. Aldemir, N. N. Yenigül, S. Dilbaz, and Ö. Moraloğlu Tekin, “AZALMIŞ OVER RESERVİ OLAN OLGULARDA LONG GNRH AGONİST, GNRH ANTAGONİST VE MİKRODOZ FLARE-UP AGONİST PROTOKOLLERİNİN IVF SONUÇLARI ÜZERİNE ETKİSİ”, Bozok Tıp Dergisi, vol. 9, no. 3, pp. 140–145, 2019.
ISNAD Özelçi, Runa et al. “AZALMIŞ OVER RESERVİ OLAN OLGULARDA LONG GNRH AGONİST, GNRH ANTAGONİST VE MİKRODOZ FLARE-UP AGONİST PROTOKOLLERİNİN IVF SONUÇLARI ÜZERİNE ETKİSİ”. Bozok Tıp Dergisi 9/3 (September 2019), 140-145.
JAMA Özelçi R, Aldemir O, Yenigül NN, Dilbaz S, Moraloğlu Tekin Ö. AZALMIŞ OVER RESERVİ OLAN OLGULARDA LONG GNRH AGONİST, GNRH ANTAGONİST VE MİKRODOZ FLARE-UP AGONİST PROTOKOLLERİNİN IVF SONUÇLARI ÜZERİNE ETKİSİ. Bozok Tıp Dergisi. 2019;9:140–145.
MLA Özelçi, Runa et al. “AZALMIŞ OVER RESERVİ OLAN OLGULARDA LONG GNRH AGONİST, GNRH ANTAGONİST VE MİKRODOZ FLARE-UP AGONİST PROTOKOLLERİNİN IVF SONUÇLARI ÜZERİNE ETKİSİ”. Bozok Tıp Dergisi, vol. 9, no. 3, 2019, pp. 140-5.
Vancouver Özelçi R, Aldemir O, Yenigül NN, Dilbaz S, Moraloğlu Tekin Ö. AZALMIŞ OVER RESERVİ OLAN OLGULARDA LONG GNRH AGONİST, GNRH ANTAGONİST VE MİKRODOZ FLARE-UP AGONİST PROTOKOLLERİNİN IVF SONUÇLARI ÜZERİNE ETKİSİ. Bozok Tıp Dergisi. 2019;9(3):140-5.
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