Document Detail


The use of gonadotropin-releasing hormone (GnRH) agonist to induce oocyte maturation after cotreatment with GnRH antagonist in high-risk patients undergoing in vitro fertilization prevents the risk of ovarian hyperstimulation syndrome: a prospective randomized controlled study.
MedLine Citation:
PMID:  17462639     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To determine whether there are any differences in the incidence of ovarian hyperstimulation syndrome (OHSS) and implantation rates in high-risk patients undergoing IVF using a protocol consisting of GnRH agonist trigger after cotreatment with GnRH antagonist or hCG trigger after dual pituitary suppression protocol. DESIGN: Prospective randomized controlled trial. SETTING: University-based tertiary fertility center. PATIENT(S): Sixty-six patients under 40 years of age with polycystic ovarian syndrome, polycystic ovarian morphology, or previous high response undergoing IVF. INTERVENTION(S): Patients were randomized to an ovarian stimulation protocol consisting of either GnRH agonist trigger after cotreatment with GnRH antagonist (study group) or hCG trigger after dual pituitary suppression with a GnRH agonist (control group). Both groups received luteal phase and early pregnancy supplementation with IM progesterone (P), and patients in the study group also received E(2) patches and their doses were adjusted according to the serum levels. MAIN OUTCOME MEASURE(S): Incidence of OHSS and implantation rate. RESULT(S): None of the patients in the study group developed any form of OHSS compared with 31% (10/32) of the patients in the control group. There were no significant differences in the implantation (22/61 [36.0%] vs. 20/64 [31.0%]), clinical pregnancy (17/30 [56.7%] vs. 15/29 [51.7%]), and ongoing pregnancy rates (16/30 [53.3%] vs. 14/29 [48.3%]) between the study and control groups, respectively. CONCLUSION(S): The use of a protocol consisting of GnRH agonist trigger after GnRH antagonist cotreatment combined with adequate luteal phase and early pregnancy E(2) and P supplementation reduces the risk of OHSS in high-risk patients undergoing IVF without affecting implantation rate.
Authors:
Lawrence Engmann; Andrea DiLuigi; David Schmidt; John Nulsen; Donald Maier; Claudio Benadiva
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2007-04-26
Journal Detail:
Title:  Fertility and sterility     Volume:  89     ISSN:  1556-5653     ISO Abbreviation:  Fertil. Steril.     Publication Date:  2008 Jan 
Date Detail:
Created Date:  2008-01-14     Completed Date:  2008-01-24     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0372772     Medline TA:  Fertil Steril     Country:  United States    
Other Details:
Languages:  eng     Pagination:  84-91     Citation Subset:  IM    
Affiliation:
Center for Advanced Reproductive Services, Department of Obstetrics and Gynecology, Dowling South Building, University of Connecticut Health Center, Farmington, Connecticut 06030-6224, USA. lengmann@uchc.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Contraceptives, Oral, Hormonal / blood,  therapeutic use
Embryo Implantation / drug effects
Estradiol / blood
Female
Fertility Agents, Female / blood,  therapeutic use*
Fertilization in Vitro*
Gonadotropin-Releasing Hormone* / agonists,  analogs & derivatives,  antagonists & inhibitors,  therapeutic use
Hormone Antagonists / therapeutic use*
Humans
Incidence
Infertility, Female / etiology,  physiopathology,  therapy*
Leuprolide / therapeutic use
Luteinizing Hormone / blood
Odds Ratio
Oocytes / drug effects*,  growth & development
Ovarian Hyperstimulation Syndrome / epidemiology,  etiology,  prevention & control*
Ovulation Induction / adverse effects*
Polycystic Ovary Syndrome / blood,  complications,  physiopathology,  therapy
Pregnancy
Pregnancy Rate
Progesterone / blood
Prospective Studies
Risk Assessment
Sperm Injections, Intracytoplasmic
Treatment Outcome
Chemical
Reg. No./Substance:
0/Contraceptives, Oral, Hormonal; 0/Fertility Agents, Female; 0/Hormone Antagonists; 123246-29-7/ganirelix; 33515-09-2/Gonadotropin-Releasing Hormone; 50-28-2/Estradiol; 53714-56-0/Leuprolide; 57-83-0/Progesterone; 9002-67-9/Luteinizing Hormone

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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