Early gonadotropin-releasing hormone antagonist protocol in women with polycystic ovary syndrome: A preliminary randomized trial.
10.5653/cerm.2018.45.3.135
- Author:
Jae Jun SHIN
1
;
Kyung Eui PARK
;
Young Min CHOI
;
Hye Ok KIM
;
Dong Hee CHOI
;
Woo Sik LEE
;
Jung Hyun CHO
Author Information
1. Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea. ymchoi@snu.ac.kr
- Publication Type:Original Article
- Keywords:
Gonadotropin-releasing hormone antagonist;
In vitro fertilization;
Ovarian hyperstimulation syndrome;
Polycystic ovary syndrome;
Pregnancy
- MeSH:
Embryo Transfer;
Female;
Fertilization in Vitro;
Gonadotropin-Releasing Hormone*;
Humans;
Incidence;
Oocytes;
Ovarian Hyperstimulation Syndrome;
Polycystic Ovary Syndrome*;
Pregnancy;
Pregnancy Rate;
Prospective Studies
- From:Clinical and Experimental Reproductive Medicine
2018;45(3):135-142
- CountryRepublic of Korea
- Language:English
-
Abstract:
OBJECTIVE: To prospectively evaluate the efficacy and safety of a fixed early gonadotropin-releasing hormone (GnRH) antagonist protocol compared to a conventional midfollicular GnRH antagonist protocol and a long GnRH agonist protocol for in vitro fertilization (IVF) in patients with polycystic ovary syndrome (PCOS). METHODS: Randomized patients in all three groups (early antagonist, n=14; conventional antagonist, n=11; long agonist, n=11) received 21 days of oral contraceptive pill treatment prior to stimulation. The GnRH antagonist was initiated on the 1st day of stimulation in the early antagonist group and on the 6th day in the conventional antagonist group. The GnRH agonist was initiated on the 18th day of the preceding cycle. The primary endpoint was the number of oocytes retrieved, and the secondary endpoints included the rate of moderate-to-severe ovarian hyperstimulation syndrome (OHSS) and the clinical pregnancy rate. RESULTS: The median total number of oocytes was similar among the three groups (early, 16; conventional, 12; agonist, 19; p=0.111). The early GnRH antagonist protocol showed statistically non-significant associations with a higher clinical pregnancy rate (early, 50.0%; conventional, 11.1%; agonist, 22.2%; p=0.180) and lower incidence of moderate-to-severe OHSS (early, 7.7%; conventional, 18.2%; agonist, 27.3%; p=0.463), especially among subjects at high risk for OHSS (early, 12.5%; conventional, 40.0%; agonist, 50.0%; p=0.324). CONCLUSION: In PCOS patients undergoing IVF, early administration of a GnRH antagonist may possibly lead to benefits due to a reduced incidence of moderate-to-severe OHSS in high-risk subjects with a better clinical pregnancy rate per embryo transfer. Further studies with more subjects are required.
