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GnRH Antagonist Improved Blastocyst Quality and Pregnancy Outcome After Multiple Failures of IVF/ICSI–ET with a GnRH Agonist Protocol

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Abstract

Background : To determine the efficacy of a gonadotrophin-releasing hormone (GnRH) antagonist, cetrorelix, in improving the quality of embryos and pregnancy outcome, we performed a study in patients with a history of multiple failures of in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) cycles with a GnRH agonist (GnRHa) long protocol.

Methods : Forty women with no live births after conventional IVF or ICSI embryo transfer (ET) and subsequent blastocyst transfer (BT) with a GnRHa long protocol entered this study. The treatment protocol consisted of a daily dose of clomiphene citrate 100 mg for 5 days and gonadotrophin injections daily from cycle day 4 onward. Cetrorelix, 0.25 mg/day, was started when the leading follicle reached 14 mm. Induction of ovulation was triggered with human chorionic gonadotrophin (HCG) (N=36) or GnRHa (N=4). It was possible to perform BT in 38 patients.

Results : Comparison of the results with the results for BT with the previous GnRHa protocol showed no significant differences in number of oocytes retrieved or the zygote- and blastocyst-development rate. With the cetrorelix protocol, however, number of patients whose embryos had developed to at least one expanded blastocyst on day 5 was significantly higher than with the GnRHa protocol (25 vs. 9) (p<0.001), and 16 of the women became pregnant (42.1%), with 7 delivering 9 infants, 4 ending in abortion (25%), and 5 in progressing.

Conclusions : The use of a GnRH antagonist in controlled ovarian hyperstimulation improves the outcome of pregnancy of patients with a history of multiple failure of IVF/ICSI–ET in a GnRHa protocol, most likely due to improvement of the quality of the blastocysts generated.

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REFERENCES

  1. Bongso A, Ng SC, Fong CY, Anandakumar C, Marshall B, Edirisinghe R, Ratnam S: Improved pregnancy rate after transfer of embryos grown in human fallopian tubal cell coculture. Fertil Steril 1992;58:569–574

    Google Scholar 

  2. Wiemer KE, Garris J, Steuerwald N, Alikani MA, Reing AM, Ferrara TA, Noyes N, Cohen J: Beneficial aspects of coculture with assisted hatching when applied to multiple failure in-vitro fertilization patients. Hum Reprod 1996;11:2429–2433

    Google Scholar 

  3. Gardner DK, Vella P, Lane M, Wagley L, Schlenker T, Schoolcraft WB: Culture and transfer of human blastocysts increases implantation rates and reduces the need for multiple embryo transfer. Fertil Steril 1998;69:84–88

    Google Scholar 

  4. Schoolcraft WB, Gardner DK, Lane M, Schlenker T, Hamilton F, Meldrum DR: Blastocyst culture and transfer: Analysis of results and parameters affecting outcome in two in vitro fertilization programs. Fertil Steril 1999;72:604–609

    Google Scholar 

  5. Marek D, Langley M, Gardner DK, Confer N, Doody KM, Doody KJ: Introduction of blastocyst culture and transfer for all patients in an in vitro fertilization program. Fertil Steril 1999;72:1035–1040

    Google Scholar 

  6. Milki AA, Hinckley MD, Fisch JD, Dasig D, Behr B: Com-parison of blastocyst transfer with day 3 embryo transfer in similar patient populations. Fertil Steril 2000;73:126–129

    Google Scholar 

  7. Cruz JR, Dubey AK, Patel J, Peak D, Hartog B, Gindoff P R: Is blastocyst transfer useful as an alternative treatment for patients with multiple in vitro fertilization failures? Fertil Steril 1999;72:218–220

    Google Scholar 

  8. Racowsky C, Jackson KV, Cekleniak NA, Fox JH, Homstein MD, Ginsburg ES: The number of eight-cell embryos is a key determinant for selecting day 3 or day 5 transfer. Fertil Steril 2000;73:558–564

    Google Scholar 

  9. Jones GM, Trouson AO, Lolatgis N, Wood C: Factors affecting the success of human blastocyst development and pregnancy following in vitro fertilization and embryo transfer. Fertil Steril 1998;70:1022–1029

    Google Scholar 

  10. Hughes EG, Sagle MA, Fedorkow DM, Van de Koppel P, Daya S, Collins JA: The routine use of gonadotropin-releasing hormone agonists prior to in vitro fertilization and gamete intrafallopian transfer: A meta-analysis of randomized controlled trials. Fertil Steril 1992;58:888–896

    Google Scholar 

  11. Minaretzis D, Jakubowski M, Mortola JF, Pavlou SN: Gonadotropin-releasing hormone receptor gene expression in human ovary and granulosa-lutein cells. J Clin Endocrinol Metab 1995;80:430–434

    Google Scholar 

  12. Olivennes F, Belaisch-Allart J, Emperaire JC, Dechaud H, Alvarez S, Moreau L, Nicollet B, Zorn JR, Bouchard P, Frydman R: Prospective, randomized, controlled study of in vitro fertilization-embryo transfer with a single dose of a luteinizing hormone-releasing hormone (LH-RH) antag-onist (cetrorelix) or depot formula of an LH-RH agonist (triptorelin). Fertil Steril 2000;73:314–320

    Google Scholar 

  13. Albano C, Felberbaum RE, Smitz J, Riethmuller-Winzen H, Engel J, Devroy P: Ovarian stimulation with HMG: Results of a prospective randomized phase III European study com-paring the luteinizing hormone-releasing hormone (LHRH) antagonist cetrorelix and the LHRH-agonist buserelin. Hum Reprod 2000;15:526–531

    Google Scholar 

  14. Garcia-Velasco JA, Isaza V, Vidal C, Landazabal A, Remohi J, Simon C, Pellicer A: Human ovarian steroid secretion in vivo: Effects of GnRH agonist versus antagonist (cetrorelix). Hum Reprod 2001;16:2533–2539

    Google Scholar 

  15. Minaretzis D, Alper MM, Oskowitz SP, Lobel SM, Mortola JF, Pavlou SN: Gonadotropin-releasing hormone antagonist versus agonist administration in women undergoing con-trolled ovarian hyperstimulation: Cycle performance and in vitro steroidogenesis of granulose-lutein cells. Am J Obstet Gynecol 1995;172:1518–1525

    Google Scholar 

  16. Craft I, Gorgy A, Hill J, Menon D, Podsiadly B: Will GnRH antagonists provide new hope for patients considered "diffi-cult responders" to GnRH agonist protocols? Hum Reprod 1999;14:2959–2962

    Google Scholar 

  17. Mukaida T, Wada S, Takahashi K, Pedro PB, An TZ, Kasai M: Vitrification of human embryos based on the assessment of suitable conditions for 8 cell mouse embryos. Hum Reprod 1998;13:2874–2879

    Google Scholar 

  18. Mukaida T, Nakamura S, Tomiyama T, Wada S, Kasai M, Takahashi K: Successful birth after transfer of vitrified human blastocysts with use of a cryoloop containerless technique. Fertil Steril 2001;76:618–620

    Google Scholar 

  19. Neveu S, Hedon B, Bringer J, Chinchole JM, Arnal F, Humeau C, Cristol P, Viala JL: Ovarian stimulation by a combination of a gonadotropin-releasing hormone agonist and gonadotropins for in vitro fertilization. Fertil Steril 1987;47:639–643

    Google Scholar 

  20. Palermo R, Amodeo G, Navot D, Rosenwaks Z, Cittadini E: Concomitant gonadotropin-releasing hormone agonist and menotropin treatment for the synchronized induction of multiple follicles. Fertil Steril 1988;49:290–295

    Google Scholar 

  21. Tur-Kaspa I, Myers SA, Confino E, Friberg J, Dudkiewicz AB, Gleicher N: Ovarian stimulation protocol for in vitro fertilization with gonadotropin-releasing hormone agonist widens the implantation window. Fertil Steril 1990;53:859–864

    Google Scholar 

  22. Gardner DK, Lane M, Stevens J, Schlenker T, Schoolcraft WB: Blastocyst score affects implantation and pregnancy outcome: Towards a single blastocyst transfer. Fertil Steril 2000;73:1155–1158

    Google Scholar 

  23. Hull MGR, Williams JAC, Ray B, McLaughlin EA, Akande VA, Ford WCL: The contribution of subtle oocyte or sperm dysfunction affecting fertilization in endometriosis-associated or unexplained infertility: A controlled comparison with tubal infertility and use of donor spermatozoa. Hum Reprod 1998;13:1825–1830

    Google Scholar 

  24. MacDougall ML, Tan SL, Balen A, Jacbs S: A controlled study comparing patients with and without polycystic ovaries undergoing in-vitro fertilization. Hum Reprod 1993;8:233–237

    Google Scholar 

  25. Itskovitz-Eldor J, Kol S, Mannaerts B: Use of a single bolus of GnRH agonist triptorelin to trigger ovulation after GnRH antagonist ganirelix treatment in women undergoing ovarian stimulation for assisted reproduction, with special reference to the prevention of ovarian hyperstimulation syndrome: Preliminary report. Hum Reprod 2000;15:1965–1968

    Google Scholar 

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Authors and Affiliations

  1. Hiroshima HART Clinic, 5-7-10 Ohtemachi, Naka-ku, Hiroshima, 730-0051, , Japan

    Katsuhiko Takahashi & Tetsunori Mukaida

  2. Osaka HART Clinic, 2-6-20 Umeda, Kita-ku, Osaka, 530-0001, Japan

    Tatsuhiro Tomiyama

  3. Tokyo HART Clinic, 1-22-2 Higashi, Shibuya-ku, Tokyo, 150-0011, Japan

    Tetsuya Goto & Chikahiro Oka

Authors
  1. Katsuhiko Takahashi
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  2. Tetsunori Mukaida
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  3. Tatsuhiro Tomiyama
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  4. Tetsuya Goto
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  5. Chikahiro Oka
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Takahashi, K., Mukaida, T., Tomiyama, T. et al. GnRH Antagonist Improved Blastocyst Quality and Pregnancy Outcome After Multiple Failures of IVF/ICSI–ET with a GnRH Agonist Protocol. J Assist Reprod Genet 21, 317–322 (2004). https://doi.org/10.1023/B:JARG.0000045470.68525.a4

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  • DOI: https://doi.org/10.1023/B:JARG.0000045470.68525.a4

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