GnRH antagonist versus long agonist protocols in IVF: a systematic review and meta-analysis accounting for patient type
Cornelis B. Lambalk,F.R. Banga,Judith A.F. Huirne,M Toftager,Anja Pinborg,R Homburg,F. van der Veen,M. van Wely +7 more
Reads0
Chats0
TLDR
In a general IVF population, GnRH antagonists are associated with lower ongoing pregnancy rates when compared to long protocol agonists, but also with lower OHSS rates; standard use of the long GnRH agonist treatment is perhaps still the approach of choice for prevention of premature luteinization.Abstract:
BACKGROUND: Most reviews of IVF ovarian stimulation protocols have insufficiently accounted for various patient populations, such as ovulatory women, women with polycystic ovary syndrome (PCOS) or women with poor ovarian response, and have included studies in which the agonist or antagonist was not the only variable between the compared study arms. OBJECTIVE AND RATIONALE: The aim of the current study was to compare GnRH antagonist protocols versus standard long agonist protocols in couples undergoing IVF or ICSI, while accounting for various patient populations and treatment schedules. SEARCH METHODS: The Cochrane Menstrual Disorders and Subfertility Review Group specialized register of controlled trials and Pubmed and Embase databases were searched from inception until June 2016. Eligible trials were those that compared GnRH antagonist protocols and standard long GnRH agonist protocols in couples undergoing IVF or ICSI. The primary outcome was ongoing pregnancy rate. Secondary outcomes were: live birth rate, clinical pregnancy rate, number of oocytes retrieved and safety with regard to ovarian hyperstimulation syndrome (OHSS). Separate comparisons were performed for the general IVF population, women with PCOS and women with poor ovarian response. Pre-planned subgroup analyses were performed for various antagonist treatment schedules. OUTCOMES: We included 50 studies. Of these, 34 studies reported on general IVF patients, 10 studies reported on PCOS patients and 6 studies reported on poor responders. In general IVF patients, ongoing pregnancy rate was significantly lower in the antagonist group compared with the agonist group (RR 0.89, 95% CI 0.82-0.96). In women with PCOS and in women with poor ovarian response, there was no evidence of a difference in ongoing pregnancy between the antagonist and agonist groups (RR 0.97, 95% CI 0.84-1.11 and RR 0.87, 95% CI 0.65-1.17, respectively). Subgroup analyses for various antagonist treatment schedules compared to the long protocol GnRH agonist showed a significantly lower ongoing pregnancy rate when the oral hormonal programming pill (OHP) pretreatment was combined with a flexible protocol (RR 0.74, 95% CI 0.59-0.91) while without OHP, the RR was 0.84, 95% CI 0.71-1.0. Subgroup analysis for the fixed antagonist schedule demonstrated no evidence of a significant difference with or without OHP (RR 0.94, 95% CI 0.79-1.12 and RR 0.94, 95% CI 0.83-1.05, respectively). Antagonists resulted in significantly lower OHSS rates both in the general IVF patients and in women with PCOS (RR 0.63, 95% CI 0.50-0.81 and RR 0.53, 95% CI 0.30-0.95, respectively). No data on OHSS was available from trials in poor responders. WIDER IMPLICATIONS: In a general IVF population, GnRH antagonists are associated with lower ongoing pregnancy rates when compared to long protocol agonists, but also with lower OHSS rates. Within this population, antagonist treatment prevents one case of OHSS in 40 patients but results in one less ongoing pregnancy out of every 28 women treated. Thus standard use of the long GnRH agonist treatment is perhaps still the approach of choice for prevention of premature luteinization. In couples with PCOS and poor responders, GnRH antagonists do not seem to compromise ongoing pregnancy rates and are associated with less OHSS and therefore could be considered as standard treatment.read more
Citations
More filters
Journal ArticleDOI
Recurrent Implantation Failure-update overview on etiology, diagnosis, treatment and future directions
TL;DR: A new initial step in approach to patients with RIF is suggested, individualized planned activities to activate the brain's reward system in attempt to improve immunological balance in the body.
Journal ArticleDOI
ESHRE guideline: ovarian stimulation for IVF/ICSI†
Ernesto Bosch,Simone L. Broer,Georg Griesinger,Michael Grynberg,Peter Humaidan,Estratios Kolibianakis,Michał Kunicki,Antonio La Marca,George T. Lainas,Nathalie Le Clef,Nathalie Massin,Sebastiaan Mastenbroek,Nikolaos P. Polyzos,Sesh Kamal Sunkara,Tanya Timeva,Mira Töyli,János Urbancsek,Nathalie Vermeulen,Frank J.M. Broekmans +18 more
TL;DR: This guideline provides clinicians with clear advice on best practice in ovarian stimulation, based on the best evidence available, and a list of research recommendations is provided to promote further studies in ovarianstimulation.
Journal ArticleDOI
Advanced Maternal Age in IVF: Still a Challenge? The Present and the Future of Its Treatment.
Filippo Maria Ubaldi,Danilo Cimadomo,Alberto Vaiarelli,Gemma Fabozzi,Roberta Venturella,Roberta Maggiulli,Rossella Mazzilli,Susanna Ferrero,Antonio Palagiano,Laura Rienzi +9 more
TL;DR: This review summarizes the main current strategies proposed for the treatment of advanced maternal age (AMA), and reviews emerging experimental therapeutic approaches to attempt at restoring maternal reproductive potential.
Journal ArticleDOI
Novel Concepts for Inducing Final Oocyte Maturation in In Vitro Fertilization Treatment.
TL;DR: Experimental and clinical data are appraised on the efficacy and safety of the major hormonal approaches used to induce final oocyte maturation in clinical practice, as well as some novel approaches that may offer fresh alternatives in future.
Journal ArticleDOI
Ovarian Reserve Markers to Identify Poor Responders in the Context of Poseidon Classification
TL;DR: The ability of ovarian reserve markers, in particular AMH and AFC, to predict poor ovarian response in IVF cycles was investigated and the efficacy of the POSEIDON approach in improving management and outcomes of POR patients has yet to be tested and validated with future prospective clinical trials.
References
More filters
Book
Cochrane Handbook for Systematic Reviews of Interventions
Julian P T Higgins,Sally Green +1 more
TL;DR: The Cochrane Handbook for Systematic Reviews of Interventions is the official document that describes in detail the process of preparing and maintaining Cochrane systematic reviews on the effects of healthcare interventions.
Journal ArticleDOI
Milder ovarian stimulation for in-vitro fertilization reduces aneuploidy in the human preimplantation embryo: a randomized controlled trial
Esther B. Baart,Elena Martini,Marinus J.C. Eijkemans,Diane Van Opstal,Nicole G. M. Beckers,Arie Verhoeff,Nick S. Macklon,Bart C.J.M. Fauser +7 more
TL;DR: Differences in rates of mosaic embryos suggest an effect of ovarian stimulation on mitotic segregation errors, and future ovarian stimulation strategies should avoid maximizing oocyte yield, but aim at generating a sufficient number of chromosomally normal embryos by reduced interference with ovarian physiology.
Journal ArticleDOI
Gonadotrophin‐releasing hormone antagonists for assisted reproductive technology
Hesham Al-Inany,Mohamed A. Youssef,Reuben Olugbenga Ayeleke,Julie Brown,Wai Sun Lam,Frank J Broekmans +5 more
TL;DR: Evaluating the effectiveness and safety of gonadotrophin-releasing hormone (GnRH) antagonists compared with the standard long protocol of GnRH agonists for controlled ovarian hyperstimulation in assisted conception cycles found no conclusive evidence of a difference in live birth rate and other adverse effects were secondary outcomes.
Journal ArticleDOI
Serum anti-Müllerian hormone and FSH: prediction of live birth and extremes of response in stimulated cycles—implications for individualization of therapy
TL;DR: Plasma AMH is a superior predictor of live birth and anticipated oocyte yield compared with FSH and age, facilitating individualization of therapy prior to first ART cycle.
Journal ArticleDOI
The use of gonadotropin-releasing hormone (GnRH) agonist to induce oocyte maturation after cotreatment with GnRH antagonist in high-risk patients undergoing in vitro fertilization prevents the risk of ovarian hyperstimulation syndrome: a prospective randomized controlled study.
TL;DR: The use of a protocol consisting of GnRH agonist trigger after GnRH antagonist cotreatment combined with adequate luteal phase and early pregnancy E(2) and P supplementation reduces the risk of OHSS in high-risk patients undergoing IVF without affecting implantation rate.