Background: To assess the effect of these two protocols in patients of different ages. Methods: 1923 in vitro fertilization and embryo transfer (IVF-ET) cycles were divided into two groups: a GnRH-ant protocol group and GnRH-a long protocol group, and then every group were subdivided into four age ranges. The general materials and IVF outcomes were compared. Results: The incidence of OHSS fluctuated from 0% to 2.37% with GnRH-ant protocol, which was significantly lower than another (P < 0.05). Of all age ranges, the implantation and clinical pregnancy rates with GnRH-ant protocol were all lower than those with GnRH-a protocol. When the age was less than 35 years old, the CPRs in GnRH-ant protocol group were significantly lower than in another group (45.56% vs. 62.29%, 46.07% vs. 55.59%, respectively; P < 0.05). Conclusion: The antagonist protocol should be considered in patients with a high ovarian response (e.g., PCOS patients) to avoid OHSS. Older patients (>35 years) could be treated with the antagonist protocol.
References
[1]
Porter, R.N., Smith, W., Craft, I.L., Abdulwahid, N.A. and Jacobs, H.S. (1984) Induction of Ovulation for In-Vitro Fertilisation Using Buserelin and Gonadotropins. Lancet, 2, 1284-1285. https://doi.org/10.1016/S0140-6736(84)92840-X
[2]
Lainas, T.G., Sfontouris, I.A., Zorzovilis, I.Z., Petsas, G.K., Lainas, G.T., Alexopoulou, E., et al. (2010) Flexible GnRH Antagonist Protocol versus GnRH Agonist Long Protocol in Patients with Polycystic Ovary Syndrome Treated for IVF: A Prospective Randomised Controlled Trial (RCT). Human Reproduction, 25, 683-689.
https://doi.org/10.1093/humrep/dep436
[3]
Check, M.L., Check, J.H., Choel, J.K., Davies, E. and Kiefer, D. (2004) Effect of Antagonists vs Agonists on In Vitro Fertilization Outcome. Clinical and Experimental Obstetrics and Gynecology, 31, 257-259.
[4]
Xing, W., Lin, H., Li, Y., Yang, D., Wang, W. and Zhang, Q. (2015) Is the GnRH Antagonist Protocol Effective at Preventing OHSS for Potentially High Responders Undergoing IVF/ICSI? PLoS One, 10, e0140286.
https://doi.org/10.1371/journal.pone.0140286
[5]
Qiao, J., Lu, G., Zhang, H.W., Chen, H., Ma, C., Olofsson, J.I., et al. (2012) A Randomized Controlled Trial of the GnRH Antagonist Ganirelix in Chinese Normal Responders: High Efficacy and Pregnancy Rates. Gynecological Endocrinology, 28, 800-804. https://doi.org/10.3109/09513590.2012.665103
[6]
Marci, R., Caserta, D., Lisi, F., Graziano, A., Soave, I., Lo Monte, G., et al. (2013) In Vitro Fertilization Stimulation Protocol for Normal Responder Patients. Gynecological Endocrinology, 29, 109-112. https://doi.org/10.3109/09513590.2012.712002
[7]
Xiao, J., Chen, S., Zhang, C. and Chang, S. (2013) Effectiveness of GnRH Antagonist in the Treatment of Patients with Polycystic Ovary Syndrome Undergoing IVF: A Systematic Review and Meta Analysis. Gynecological Endocrinology, 29, 187-191. https://doi.org/10.3109/09513590.2012.736561
[8]
Wang, H.Y., Li, Y.X., Dun, L.L., Xu, T.T., Hao, Y.J., Liu, H.Y., et al. (2013) Antinociceptive Effects of Matrine on Neuropathic Pain Induced by Chronic Constriction Injury. Pharmaceutical Biology, 51, 844-850.
https://doi.org/10.3109/13880209.2013.767363
[9]
Pundir, J., Sunkara, S.K., El-Toukhy, T. and Khalaf, Y. (2012) Meta-Analysis of GnRH Antagonist Protocols: Do They Reduce the Risk of OHSS in PCOS? Reproductive BioMedicine Online, 24, 6-22. https://doi.org/10.1016/j.rbmo.2011.09.017
[10]
Kolibianakis, E.M., Griesinger, G. and Venetis, C.A. (2012) GnRH Agonist for Triggering Final Oocyte Maturation: Time for a Critical Evaluation of Data. Human Reproduction Update, 18, 228-229; Author Reply 9-30.
https://doi.org/10.1093/humupd/dmr055
[11]
Al-Inany, H.G., Youssef, M.A., Aboulghar, M., Broekmans, F., Sterrenburg, M., Smit, J., et al. (2011) Gonadotrophin-Releasing Hormone Antagonists for Assisted Reproductive Technology. The Cochrane Database of Systematic Reviews, 2011, CD001750.
[12]
Hershko Klement, A., Berkovitz, A., Wiser, A., Gonen, O., Amichay, K., Cohen, I., et al. (2015) GnRH-Antagonist Programming versus GnRH Agonist Protocol: A Randomized Trial. The European Journal of Obstetrics & Gynecology and Reproductive Biology, 185, 170-173.
[13]
Copperman, A.B. and Benadiva, C. (2013) Optimal Usage of the GnRH Antagonists: A Review of the Literature. Reproductive Biology and Endocrinology, 11, 20.
https://doi.org/10.1186/1477-7827-11-20
[14]
Vaisbuch, E., de Ziegler, D., Leong, M., Weissman, A. and Shoham, Z. (2014) Luteal-Phase Support in Assisted Reproduction Treatment: Real-Life Practices Reported Worldwide by an Updated Website-Based Survey. Reproductive BioMedicine Online, 28, 330-335.
[15]
Oberye, J.J., Mannaerts, B.M., Huisman, J.A. and Timmer, C.J. (1999) Pharmacokinetic and Pharmacodynamic Characteristics of Ganirelix (Antagon/Orgalutran). Part II. Dose-Proportionality and Gonadotropin Suppression after Multiple Doses of Ganirelix in Healthy Female Volunteers. Fertility and Sterility, 72, 1006-1012.
[16]
Youssef, M.A., Van der Veen, F., Al-Inany, H.G., Griesinger, G., Mochtar, M.H., Aboulfoutouh, I., et al. (2011) Gonadotropin-Releasing Hormone Agonist versus HCG for Oocyte Triggering in Antagonist Assisted Reproductive Technology Cycles. The Cochrane Database of Systematic Reviews, 2011, CD008046.
https://doi.org/10.1002/14651858.CD008046.pub3