[Effects of cetrorelix versus ganirelix in gonadotropin-releasing hormone antagonist cycles for preventing premature luteinizing hormone surges and on clinical outcomes of IVF-ET cycles]

A premature luteinizing hormone surge without elevated progesterone levels has no adverse effect on cumulative live birth rate in patient undergoing a flexible GnRH antagonist protocol: a retrospective study

BACKGROUND

A premature luteinizing hormone (LH) surge refers to an endogenous LH peak that occurs before follicle maturation or human chorionic gonadotropin injection in the process of controlled ovarian hyperstimulation. The effect of premature LH surge on pregnancy outcomes in fresh embryo transfer cycles is still controversial. The aim of this study was to explore the effect of a premature LH surge without elevated progesterone levels on the cumulative pregnancy rate (CPR) and cumulative live birth rate (CLBR) of patients during a flexible GnRH antagonist protocol.

METHODS

A total of 730 infertile women undergoing IVF/ICSI were recruited for this retrospective study. Only women who either delivered a live infant or had no remaining frozen embryos after a single stimulation cycle were included in the analysis. During the study period, each patient underwent a flexible GnRH antagonist protocol. Women were divided into two groups according to the presence or absence of a premature LH surge. The primary outcome measures were the CPR and CLBR per ovarian stimulation cycle. The secondary outcome measures were the number of oocytes retrieved, fertilization rate, good-quality embryo rate, and clinical pregnancy rate.

RESULTS

Ninety-one women (12.47%) experienced a premature LH surge without elevated progesterone levels, and the other 639 (87.53%) women were assigned to the control group. The numbers of oocytes retrieved and fertilization rate were significantly greater in the premature LH surge group than in the control group. There was no significant difference between groups in the good-quality embryo rate, clinical pregnancy rate or live birth rate in the fresh embryo transfer cycle. The primary outcome measures, the CPR and CLBR per ovarian stimulation cycle, were not significantly different between the premature LH surge group and the control group. According to the analysis stratified by ovarian response (normal or high), there were no significant differences in pregnancy outcomes between the groups with and without a premature LH surge.

CONCLUSIONS

The retrospective study demonstrated that the patients experiencing a transient premature LH surge without progesterone elevation had equivalent pregnancy outcomes with those without a premature LH surge on a flexible GnRH antagonist protocol. The present conclusions need to be further validated in a prospective well-designed large-scale study.

Application of antagonist regimen in patients with failed pregnancy assisted by previous long-term regimen during early follicular phase

OBJECTIVE

To investigate the clinical application of gonadotropin-releasing hormone antagonist (GnRH-ant) in patients with failed pregnancy assisted by the previous long-term regimen during early follicular phase (EFP).

METHODS

A total of 122 patients with good ovarian function and two previous failed EFP long-term assisted pregnancy were selected from the reproductive center of our hospital for study. All patients were assisted by in vitro fertilization-embryo transfer (IVF-ET) twice. According to the random number table method, the participants were divided into group A (n=61) for subcutaneous injection of gonadotropin-releasing hormone agonist (GnRH-a) and group B (n=61) for GnRH-ant, and the clinical efficacy of the two groups were observed.

RESULTS

Group B presented reduced dosage and duration of Gn, increased number and probability of eggs retrieved, and increased number of 2PN, cleavage and transplantable embryos than group A (all P<0.05). Serum estradiol (E2) and luteinizing hormone (LH) levels elevated and T level decreased in group B as compared to group A (all P<0.05). There was no significant difference in follicle-stimulating hormone (FSH) indexes between the two groups (P>0.05). Endometrial thickness and mean ovarian volume (MOV, the mean volume of bilateral ovaries) were not significantly different between group A and group B before treatment (both P>0.05), while were lower in group B than in group A after treatment (both P<0.05). Group B had higher high-quality egg rate (%), fertilization rate (should have numbers here %), cleavage rate (%), high-quality embryo rate (should have numbers here %) and cumulative pregnancy rate (%) than group A (all P<0.05). The incidences of moderate OHSS, early abortion and hydrosalpinx were lower in group B than in group A (all P<0.05), while there was no evident difference between the two groups in the occurrence of severe OHSS and ectopic pregnancy (both P>0.05).

CONCLUSION

GnRH-ant can improve the clinical high-quality embryo rate in patients with the previous failed EFP long-term assisted pregnancy, and reduce the occurrence of OHSS events. Compared with GnRH-a, GnRH-ant is more suitable for clinical application of controlled ovarian hyperstimulation.