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GnRH antagonists in ovarian stimulation for IVF.
Hum Reprod Update. 2006 Jul-Aug; 12(4):333-40.HR

Abstract

The present review describes, on the basis of the currently available evidence, the consensus reached by a group of experts on the use of gonadotropin-releasing hormone (GnRH) antagonists in ovarian stimulation for IVF. The single or multiple low-dose administration of GnRH antagonist during the late-follicular phase effectively prevents a premature rise in serum luteinizing hormone (LH) levels in most women. Although controversy remains, most comparative studies suggest a slight, not significant reduction in the probability of pregnancy after IVF using GnRH antagonist versus GnRH agonist co-treatment. Published meta-analyses suggest that this slight difference in pregnancy rates is not attributed to chance. Further studies applying varying treatment regimens and outcome measures are required. Data are not in favour of a need to modify the starting dose of gonadotropins. Data are not in favour of increasing gonadotropin dose at GnRH antagonist initiation. The addition of LH from the initiation of ovarian stimulation or from GnRH antagonist administration does not appear to be necessary. Replacement of human chorionic gonadotropin (HCG) by GnRH agonist for triggering final oocyte maturation is associated with a lower probability of pregnancy. The optimal timing for HCG administration needs to be explored further. GnRH antagonist initiation on day 6 of stimulation appears to be superior to flexible initiation by a follicle of 14-16 mm, although earlier GnRH antagonist administration is worth further evaluation. Luteal phase supplementation in GnRH antagonist protocols remains mandatory in IVF. Effects of GnRH antagonist co-treatment on the incidence of ovarian hyperstimulation syndrome remains uncertain, although a trend is present in favour of the GnRH antagonists. The role of GnRH antagonists in ovarian stimulation for IVF appears to be promising, although many questions regarding preferred dose regimens and effects on clinical outcomes remain.

Authors+Show Affiliations

Unit for Human Reproduction, 1st Department of Obstetrics and Gynaecology, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Nea Efkarpia Peripheral Road, Thessaloniki 54603, Greece. tarlatzis@hol.grNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

16567347

Citation

Tarlatzis, B C., et al. "GnRH Antagonists in Ovarian Stimulation for IVF." Human Reproduction Update, vol. 12, no. 4, 2006, pp. 333-40.
Tarlatzis BC, Fauser BC, Kolibianakis EM, et al. GnRH antagonists in ovarian stimulation for IVF. Hum Reprod Update. 2006;12(4):333-40.
Tarlatzis, B. C., Fauser, B. C., Kolibianakis, E. M., Diedrich, K., Rombauts, L., & Devroey, P. (2006). GnRH antagonists in ovarian stimulation for IVF. Human Reproduction Update, 12(4), 333-40.
Tarlatzis BC, et al. GnRH Antagonists in Ovarian Stimulation for IVF. Hum Reprod Update. 2006 Jul-Aug;12(4):333-40. PubMed PMID: 16567347.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - GnRH antagonists in ovarian stimulation for IVF. AU - Tarlatzis,B C, AU - Fauser,B C, AU - Kolibianakis,E M, AU - Diedrich,K, AU - Rombauts,L, AU - Devroey,P, Y1 - 2006/03/27/ PY - 2006/3/29/pubmed PY - 2006/8/30/medline PY - 2006/3/29/entrez SP - 333 EP - 40 JF - Human reproduction update JO - Hum. Reprod. Update VL - 12 IS - 4 N2 - The present review describes, on the basis of the currently available evidence, the consensus reached by a group of experts on the use of gonadotropin-releasing hormone (GnRH) antagonists in ovarian stimulation for IVF. The single or multiple low-dose administration of GnRH antagonist during the late-follicular phase effectively prevents a premature rise in serum luteinizing hormone (LH) levels in most women. Although controversy remains, most comparative studies suggest a slight, not significant reduction in the probability of pregnancy after IVF using GnRH antagonist versus GnRH agonist co-treatment. Published meta-analyses suggest that this slight difference in pregnancy rates is not attributed to chance. Further studies applying varying treatment regimens and outcome measures are required. Data are not in favour of a need to modify the starting dose of gonadotropins. Data are not in favour of increasing gonadotropin dose at GnRH antagonist initiation. The addition of LH from the initiation of ovarian stimulation or from GnRH antagonist administration does not appear to be necessary. Replacement of human chorionic gonadotropin (HCG) by GnRH agonist for triggering final oocyte maturation is associated with a lower probability of pregnancy. The optimal timing for HCG administration needs to be explored further. GnRH antagonist initiation on day 6 of stimulation appears to be superior to flexible initiation by a follicle of 14-16 mm, although earlier GnRH antagonist administration is worth further evaluation. Luteal phase supplementation in GnRH antagonist protocols remains mandatory in IVF. Effects of GnRH antagonist co-treatment on the incidence of ovarian hyperstimulation syndrome remains uncertain, although a trend is present in favour of the GnRH antagonists. The role of GnRH antagonists in ovarian stimulation for IVF appears to be promising, although many questions regarding preferred dose regimens and effects on clinical outcomes remain. SN - 1355-4786 UR - https://www.unboundmedicine.com/medline/citation/16567347/GnRH_antagonists_in_ovarian_stimulation_for_IVF_ L2 - https://academic.oup.com/humupd/article-lookup/doi/10.1093/humupd/dml001 DB - PRIME DP - Unbound Medicine ER -