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

Öz

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

Anahtar Kelimeler

• In vitro fertilization
• GnRH Agonist
• GnRH Antagonist
• Icro dose flare-up protocol
• Diminished ovarian reserve

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

Öz

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. 

Anahtar Kelimeler

• In vitro fertilizasyon
• GnRH agonist
• GnRH antagonist
• Mikrodoz flare-up protokol
• Azalmış over reservi

Kaynakça

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