Effect of the Using Time of Different Gonadotropin-releasing Hormone Agonist on Clinical Outcomes during Controlled Ovarian Stimulation_West China Medical Journal

Authors：

 LUOShan , LIShang-wei , MAQian-hong , JINSong , LIXiao-hong , QINLang ,  BAIYu

The Reproductive Medical Center, West China Second Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

BAIYu, Email: 1812610795@qq.com

Keywords：

In vitro fertilization-embryo transfer; Controlled ovarian hyperstimulation; Gonadotropin-releasing hormone agonist

DOI：

10.7507/1002-0179.20140330

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Objective To compare the clinical outcomes of different pituitary down regulation protocols with gonadotropin-releasing hormone agonist (GnRH-a) in patients undergoing in vitro fertilization and embryo transfer (IVF-ET) treatment. Methods The clinical data of 358 IVF cycles in women at 40 years old or younger from November 2012 to January 2013 in the West China Second University Hospital were analyzed retrospectively. All the 358 cycles were divided into two groups, according to whether the leading follicle diameter was <14 mm (group A, 158 cycles) or ≥14 mm (group B, 200 cycles) after discontinuing the GnRH-a. The clinical outcomes were compared between the two groups. Results Compared with group B, the amount of gonadotropins used was significantly more, and the time of gonadotropin use was also significantly longer in group A (P<0.05). However, the serum level of estradiol (E2), progesterone (P) and Luteinizing hormone (LH), incidence of premature P rise, retrieved ovum number, the rates of implantation, clinical pregnancy, miscarriage and live birth did not significantly differ between the two groups (P>0.05). Conclusion Discontinuing the use of GnRH-a in early stage of controlled ovarian stimulation can keep effective pituitary down regulation and it has the same optimal clinical outcomes in patients undergoing IVF-ET.

Citation： LUOShan, LIShang-wei, MAQian-hong, JINSong, LIXiao-hong, QINLang, BAIYu. Effect of the Using Time of Different Gonadotropin-releasing Hormone Agonist on Clinical Outcomes during Controlled Ovarian Stimulation. West China Medical Journal, 2014, 29(6): 1082-1085. doi: 10.7507/1002-0179.20140330 Copy

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2.	Papanikolaou EG, Kolibianakis EM, Pozzobon C, et al. Progesterone rise on the day of human chorionic gonadotropin administration impairs pregnancy outcome in day 3 single-embryo transfer, while has no effect on day 5 single blastocyst transfer[J]. Fertil Steril, 2009, 91(3): 949-952.
3.	Fanchin R, Righini C, Olivennes F, et al. Consequences of premature progesterone elevation on the outcome of in vitro fertilization: insights into a controversy[J]. Fertil Steril, 1997, 68(5): 799-805.
4.	Kyrou D, Popovic-Todorovic B, Fatemi HM, et al. Does the estradiol level on the day of human chorionic gonadotrophin administration have an impact on pregnancy rates in patients treated with rec-FSH/GnRH antagonist?[J]. Hum Reprod, 2009, 24(11): 2902-2909.
5.	Karligiotou E, Kollia P, Kallitsaris A, et al. Expression of human serum albumin (HSA) mRNA in human granulosa cells: potential correlation of the 95 amino acid long carboxyl terminal of HSA to gonadotrophin surge-attenuating factor[J]. Hum Reprod, 2006, 21(3): 645-650.
6.	Shoham Z. The clinical therapeutic window for luteinizing hormone in controlled ovarian stimulation[J]. Fertil Steril, 2002, 77(6): 1170-1177.
7.	Fleming R, Chung CC, Yates RW, et al. Purified urinary follicle stimulating hormone induces different hormone profiles compared with menotrophins, dependent upon the route of administration and endogenous luteinizing hormone activity[J]. Hum Reprod, 1996, 11(9): 1854-1858.
8.	Wong PC, Qiao J, Ho C, et al. Current opinion on use of luteinizing hormone supplementation in assisted reproduction therapy: an Asian perspective[J]. Reprod Biomed Online, 2011, 23(1): 81-90.
9.	Lahoud R,Al-Jefout M,Tyler J, et al. A relative reduction in mid-follicular LH concentrations during GnRH agonist IVF/ICSI cycles leads to lower live birth rates[J]. Hum Reprod, 2006, 21(10): 2645-2649.
10.	Janssens RM, Vermeiden JP, Lambalk CB, et al. Gonadotrophin-releasing hormone agonist dose-dependency of pituitary desensitization during controlled ovarian hyperstimulation in IVF[J]. Hum Reprod, 1998, 13(9): 2386-2391.
11.	朱文杰, 李雪梅, 陳秀敏, 等. 長方案中兩種小劑量曲普瑞林對垂體降調節的效果研究[J]. 中國優生與遺傳雜志, 2003, 11(4): 103-105.
12.	Cambiaghi AS, Leao RBF, Castellotti DS, et al. Triptorelin every other day can prevent premature LH surge: a strategy to reduce the daily gonadotrophin-releasing hormone agonists injections[J]. Fertil and Steril, 2011, 96( Suppl 3): s175.
13.	Huang R, Fang C, Xu SY, et al. Premature progesterone rise negatively correlated with live birth rate in IVF cycles with GnRH agonist: an analysis of 2,566 cycles[J]. Fertil Steril, 2012, 98(3): 664-U433.
14.	Bosch E, Labarta E, Crespo J, et al. Circulating progesterone levels and ongoing pregnancy rates in controlled ovarian stimulation cycles for in vitro fertilization: analysis of over 4000 cycles[J]. Hum Reprod, 2010, 25(8): 2092-2100.
15.	王玢, 孫海翔, 劉景瑜, 等. 適當延長GnRH-a降調節時間對卵泡發育同步性的影響[J]. 中華男科學雜志, 2011, 17(12): 1087-1091.
16.	李靜, 聞姬, 孫偉, 等. 促性腺激素用藥前垂體降調節時間對妊娠結局的影響[J]. 實用醫學雜志, 2008, 24(9): 1530-1532.
17.	王玢, 孫海翔, 劉景瑜, 等. 長方案垂體降調節時間對卵泡發育的影響[J]. 生殖醫學雜志, 2013, 22(10): 753-756.
18.	Ferraretti AP, Gianaroli L, Magli MC, et al. Exogenous luteinizing hormone in controlled ovarian hyperstimulation for assisted reproduction techniques[J]. Fertil Steril, 2004, 82(6): 1521-1526.

1. Porter RN, Smith W, Craft IL, et al. Induction of ovulation for invitro fertilisation using buserelin and gonadotropins[J]. Lancet, 1984, 2(8414): 1284-1285.
2. Papanikolaou EG, Kolibianakis EM, Pozzobon C, et al. Progesterone rise on the day of human chorionic gonadotropin administration impairs pregnancy outcome in day 3 single-embryo transfer, while has no effect on day 5 single blastocyst transfer[J]. Fertil Steril, 2009, 91(3): 949-952.
3. Fanchin R, Righini C, Olivennes F, et al. Consequences of premature progesterone elevation on the outcome of in vitro fertilization: insights into a controversy[J]. Fertil Steril, 1997, 68(5): 799-805.
4. Kyrou D, Popovic-Todorovic B, Fatemi HM, et al. Does the estradiol level on the day of human chorionic gonadotrophin administration have an impact on pregnancy rates in patients treated with rec-FSH/GnRH antagonist?[J]. Hum Reprod, 2009, 24(11): 2902-2909.
5. Karligiotou E, Kollia P, Kallitsaris A, et al. Expression of human serum albumin (HSA) mRNA in human granulosa cells: potential correlation of the 95 amino acid long carboxyl terminal of HSA to gonadotrophin surge-attenuating factor[J]. Hum Reprod, 2006, 21(3): 645-650.
6. Shoham Z. The clinical therapeutic window for luteinizing hormone in controlled ovarian stimulation[J]. Fertil Steril, 2002, 77(6): 1170-1177.
7. Fleming R, Chung CC, Yates RW, et al. Purified urinary follicle stimulating hormone induces different hormone profiles compared with menotrophins, dependent upon the route of administration and endogenous luteinizing hormone activity[J]. Hum Reprod, 1996, 11(9): 1854-1858.
8. Wong PC, Qiao J, Ho C, et al. Current opinion on use of luteinizing hormone supplementation in assisted reproduction therapy: an Asian perspective[J]. Reprod Biomed Online, 2011, 23(1): 81-90.
9. Lahoud R,Al-Jefout M,Tyler J, et al. A relative reduction in mid-follicular LH concentrations during GnRH agonist IVF/ICSI cycles leads to lower live birth rates[J]. Hum Reprod, 2006, 21(10): 2645-2649.
10. Janssens RM, Vermeiden JP, Lambalk CB, et al. Gonadotrophin-releasing hormone agonist dose-dependency of pituitary desensitization during controlled ovarian hyperstimulation in IVF[J]. Hum Reprod, 1998, 13(9): 2386-2391.
11. 朱文杰, 李雪梅, 陳秀敏, 等. 長方案中兩種小劑量曲普瑞林對垂體降調節的效果研究[J]. 中國優生與遺傳雜志, 2003, 11(4): 103-105.
12. Cambiaghi AS, Leao RBF, Castellotti DS, et al. Triptorelin every other day can prevent premature LH surge: a strategy to reduce the daily gonadotrophin-releasing hormone agonists injections[J]. Fertil and Steril, 2011, 96( Suppl 3): s175.
13. Huang R, Fang C, Xu SY, et al. Premature progesterone rise negatively correlated with live birth rate in IVF cycles with GnRH agonist: an analysis of 2,566 cycles[J]. Fertil Steril, 2012, 98(3): 664-U433.
14. Bosch E, Labarta E, Crespo J, et al. Circulating progesterone levels and ongoing pregnancy rates in controlled ovarian stimulation cycles for in vitro fertilization: analysis of over 4000 cycles[J]. Hum Reprod, 2010, 25(8): 2092-2100.
15. 王玢, 孫海翔, 劉景瑜, 等. 適當延長GnRH-a降調節時間對卵泡發育同步性的影響[J]. 中華男科學雜志, 2011, 17(12): 1087-1091.
16. 李靜, 聞姬, 孫偉, 等. 促性腺激素用藥前垂體降調節時間對妊娠結局的影響[J]. 實用醫學雜志, 2008, 24(9): 1530-1532.
17. 王玢, 孫海翔, 劉景瑜, 等. 長方案垂體降調節時間對卵泡發育的影響[J]. 生殖醫學雜志, 2013, 22(10): 753-756.
18. Ferraretti AP, Gianaroli L, Magli MC, et al. Exogenous luteinizing hormone in controlled ovarian hyperstimulation for assisted reproduction techniques[J]. Fertil Steril, 2004, 82(6): 1521-1526.

West China Medical Journal

Effect of the Using Time of Different Gonadotropin-releasing Hormone Agonist on Clinical Outcomes during Controlled Ovarian Stimulation

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