The effects of GnRH antagonist on the endometrium of normally menstruating women

The effectiveness of gonadotropin-releasing hormone antagonist in poor ovarian responders undergoing in vitro fertilization: a systematic review and meta-analysis

OBJECTIVE

To evaluate the effectiveness of gonadotropin-releasing hormone (GnRH) antagonist in poor ovarian responders undergoing in vitro fertilization (IVF).

DESIGN

Systematic review and meta-analysis.

SETTING

Affiliated hospital with a medical university.

PATIENT(S)

None.

INTERVENTION(S)

Electronic search.

MAIN OUTCOME MEASURE(S)

Clinical pregnancy rate, number of oocytes retrieved, cycle cancellation rate.

RESULT(S)

A total of 12 published studies (1,332 cases) were included. Both the stimulation period (mean difference [MD], -0.43; 95% confidence interval [CI], -0.68 to -0.17) and the gonadotropin dosage (MD, -5.41; 95% CI, -7.51 to -3.31) were statistically significantly lower in the GnRH antagonist protocol than in the long GnRH agonist protocol. Both the endometrial thickness (MD -0.45; 95% CI, -0.76 to -0.13) and estrogen (E2) level on the day of hCG administration (MD, -1,299.15; 95% CI, -1,716.34 to -881.95) were statistically significantly lower in the GnRH antagonist protocol than the GnRH agonist protocol. Fewer oocytes were retrieved for the GnRH antagonist protocol than the long GnRH agonist protocol (MD, -0.34; 95% CI, -0.54 to -0.13) or the short GnRH agonist protocol (MD, -0.54; 95% CI, -0.9, 8 to -0.10). The cycle cancellation and clinical pregnancy rates were not statistically significantly different between the two groups.

CONCLUSION(S)

Compared with GnRH agonist protocols, the GnRH antagonist protocol is associated with fewer oocytes retrieved, lower E2 levels, and thinner endometrium whereas the clinical pregnancy and cycle cancellation rates are similar.

HOXA10 protein expression in the endometrium of normally menstruating women after receiving GnRH antagonist

OBJECTIVE(S)

To compare HOXA10 protein expression in the endometrium between natural control cycles and GnRH antagonist-treated cycles obtained during the window of implantation of normally menstruating women.

STUDY DESIGN

This study was conducted at the Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. Thirty-five volunteers were recruited into this prospective, self-controlled study, which was divided into two cycles, the first a natural control cycle and the second a GnRH antagonist-treated cycle. The two cycles were separated by one resting cycle. In the GnRH antagonist-treated cycle, when the leading follicle was 15 mm, ganirelix (Orgalutran®) 0.25mg was administered daily. In both cycles, ovulation was induced when the largest follicle reached 18 mm in diameter. Finally, endometrial biopsy was performed on day 6 after documented ovulation, which corresponds to the window of implantation. Endometrial HOXA10 protein expression, a marker of endometrial receptivity, was analyzed by immunohistochemistry. The protein expression was compared between the two cycles regarding their percentage of immunostained cells and IHC-scores (percentage of stained cells×intensity of nuclear staining).

RESULTS

HOXA10 protein was exclusively localized in the stromal compartment of the endometrium. The percentage of HOXA10 nuclear staining in the endometrium collected from GnRH antagonist-treated cycles was higher than that of the natural cycles, whereas the IHC-scores showed no difference between the two cycles.

CONCLUSION(S)

GnRH antagonists may have no effect on HOXA10 protein expression in the endometrium obtained during the implantation window of normally menstruating women.

Investigation of pregnancy outcome and ovarian hyper stimulation syndrome prevention in agonist and antagonist gonadotropin-releasing hormone protocol

BACKGROUND

Given the controversies regarding the effectiveness of gonadotropin-releasing hormone (GnRH) antagonists in prevention of ovarian hyper stimulation syndrome stimulation, this study was designed to compare GnRH agonist protocol with GnRH antagonist protocol in patients who were candidate for assisted reproductive techniques (ARTs).

MATERIALS AND METHODS

This investigation was performed on 136 patients who were randomly allocated to two groups of GnRH agonist and GnRH antagonist. In the first group stimulation was performed by administration of Buserelin, and in the second group, it was performed by giving Cetrorelix. Then patients were compared regarding results of ovarian stimulation, pregnancy outcomes and rate of ovarian hyper stimulation syndrome (OHSS).

RESULTS

There were not significant differences between 2 groups regarding the ovarian stimulation, pregnancy outcomes and rate of OHSS (P value >0.05).

CONCLUSION

Administration of GnRH antagonists in ovarian stimulation will be a reasonable option to GnRH agonists in assessment reproduction treatment; however, further studies are suggested.

Outcome of cryopreserved-thawed embryo transfer in the GnRH agonist versus antagonist protocol

BACKGROUND

GnRH agonist and antagonist were developed to control the premature release of LH surge. There is some difference between two protocols.

OBJECTIVE

We compared the outcome of frozen-thawed embryo transfer in infertile women who used GnRH agonist or antagonist protocol for previous COH cycle and evaluation of any adverse effect of GnRH antagonist on oocyte and embryo.

MATERIALS AND METHODS

The study group included all infertile women who referred to Yazd Research and Clinical Center for Infertility. Overall 20-35 years old women who were candidate for frozen-thawed embryo transfer with regard to inclusion and exclusion criteria were participated in the study. The patients based on previous control ovarian stimulation (COH) protocol divided in to two groups: GnRH agonist long protocol (n=165) and GnRH antagonist multiple dose protocol (n=165). Frozen-thawed embryos were transferred after endometrial preparation in both groups. Main outcome measures were: implantation, chemical and clinical pregnancy rate.

RESULTS

The implantation and clinical pregnancy rate following cryopreserved embryo transfer in GnRH agonist group and antagonist group were 16.3% vs. 15.7% (p=0.806) and 38.1% (63/165) vs. 36.9% (61/165) (p=0.915) and chemical pregnancy rate was 44.8% (74/165) vs. 43.6% (72/165) (p=0.915) respectively.

CONCLUSION

There was no statistically difference between two groups in terms of implantation and pregnancy rate. Although pregnancy rate in fresh embryo transfer in antagonist cycles was lower than agonist groups, Therefore decrease in these parameters might be due to detrimental effect of GnRH antagonist on the endometrium, not embryo or oocyte.