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Comparisons of different dosages of gonadotropin-releasing hormone (GnRH) antagonist, short-acting form and single, half-dose, long-acting form of GnRH agonist during controlled ovarian hyperstimulation and in vitro fertilization.
Taiwan J Obstet Gynecol 2008; 47(1):66-74TJ

Abstract

OBJECTIVE

Both gonadotropin-releasing hormone (GnRH) analogs and antagonists have been used for pituitary desensitization during controlled ovarian hyperstimulation (COH). We aimed to determine the minimum effective daily dose of GnRH antagonist in women undergoing COH. We also compared the efficiency of a GnRH antagonist and a GnRH agonist.

MATERIALS AND METHODS

Women undergoing in vitro fertilization/intracytoplasmic sperm injection and embryo transfer were divided into five groups: (1) cetrorelix 0.25 mg (n = 86); (2) cetrorelix 0.2 mg (n = 28); (3) cetrorelix 0.15 mg (n = 30); (4) leuprolide acetate (LA) 0.5 mg/day (n = 58); (5) single half-dose LA depot 1.88 mg (n = 49). Cetrorelix was administered daily from menstrual day 8 until the day of human chorionic gonadotropin administration. LA or LA depot was started on day 21 of the previous menstrual cycle.

RESULTS

We observed lower gonadotropin (Gn) dosages, estradiol (E2) levels and reduced risk of ovarian hyperstimulation syndrome (OHSS) in the GnRH antagonist groups. A higher risk of luteinizing hormone (LH) surge was noted in cetrorelix 0.2 and 0.15 mg groups. Gn dosages (IU)/E2 levels (pg/mL) in each group were: (1) 1,949.4/1,191.1; (2) 1,869.6/1,010.8; (3) 1,856.7/1,023.6; (4) 2,184.5/1,323.6; and (5) 2,103.5/1,313.5, respectively. LH/OHSS risks were: (1) 3.5%/5.8%; (2) 7.1%/3.6%; (3) 13.3%/3.3%; (4) 3.4%/8.6%; and (5) 2%/8.2%, respectively. Number of oocytes/embryos/grade I, II embryos were: (1) 9.4/7.9/5.8; (2) 7.5/4.2/3.6; (3) 6.3/4.1/3.1; (4) 12.3/8.9/6.6; and (5) 11.8/8.4/6.1, respectively. There was no significant difference in terms of clinical outcomes between groups 1, 4 and 5, except for higher abortion rates (AR) in group 1. Pregnancy rate (PR)/implantation rate (IR) ratios in groups 1, 4, and 5 were statistically higher than those in groups 2 and 3. Chemical PR/IR/AR were: (1) 30.2%/5.9%/7%; (2) 21.4%/5.1%/7.1%; (3) 16.7%/4.1%/10%; (4) 32.8%/5.5%/8.6%; and (5) 30.6%/5.7%/8.2%, respectively.

CONCLUSION

The lowest effective dosage of cetrorelix for pituitary desensitization during COH luteolysis is 0.25 mg, resulting in a comparable PR but a higher AR when compared with GnRH agonist.

Authors+Show Affiliations

Department of Obstetrics and Gynecology, China Medical University Hospital, Taichung, Taiwan.No affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial, Phase III
Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

18400585

Citation

Hsieh, Yao-Yuan, et al. "Comparisons of Different Dosages of Gonadotropin-releasing Hormone (GnRH) Antagonist, Short-acting Form and Single, Half-dose, Long-acting Form of GnRH Agonist During Controlled Ovarian Hyperstimulation and in Vitro Fertilization." Taiwanese Journal of Obstetrics & Gynecology, vol. 47, no. 1, 2008, pp. 66-74.
Hsieh YY, Chang CC, Tsai HD. Comparisons of different dosages of gonadotropin-releasing hormone (GnRH) antagonist, short-acting form and single, half-dose, long-acting form of GnRH agonist during controlled ovarian hyperstimulation and in vitro fertilization. Taiwan J Obstet Gynecol. 2008;47(1):66-74.
Hsieh, Y. Y., Chang, C. C., & Tsai, H. D. (2008). Comparisons of different dosages of gonadotropin-releasing hormone (GnRH) antagonist, short-acting form and single, half-dose, long-acting form of GnRH agonist during controlled ovarian hyperstimulation and in vitro fertilization. Taiwanese Journal of Obstetrics & Gynecology, 47(1), pp. 66-74. doi:10.1016/S1028-4559(08)60057-1.
Hsieh YY, Chang CC, Tsai HD. Comparisons of Different Dosages of Gonadotropin-releasing Hormone (GnRH) Antagonist, Short-acting Form and Single, Half-dose, Long-acting Form of GnRH Agonist During Controlled Ovarian Hyperstimulation and in Vitro Fertilization. Taiwan J Obstet Gynecol. 2008;47(1):66-74. PubMed PMID: 18400585.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparisons of different dosages of gonadotropin-releasing hormone (GnRH) antagonist, short-acting form and single, half-dose, long-acting form of GnRH agonist during controlled ovarian hyperstimulation and in vitro fertilization. AU - Hsieh,Yao-Yuan, AU - Chang,Chi-Chen, AU - Tsai,Horng-Der, PY - 2008/4/11/pubmed PY - 2008/5/21/medline PY - 2008/4/11/entrez SP - 66 EP - 74 JF - Taiwanese journal of obstetrics & gynecology JO - Taiwan J Obstet Gynecol VL - 47 IS - 1 N2 - OBJECTIVE: Both gonadotropin-releasing hormone (GnRH) analogs and antagonists have been used for pituitary desensitization during controlled ovarian hyperstimulation (COH). We aimed to determine the minimum effective daily dose of GnRH antagonist in women undergoing COH. We also compared the efficiency of a GnRH antagonist and a GnRH agonist. MATERIALS AND METHODS: Women undergoing in vitro fertilization/intracytoplasmic sperm injection and embryo transfer were divided into five groups: (1) cetrorelix 0.25 mg (n = 86); (2) cetrorelix 0.2 mg (n = 28); (3) cetrorelix 0.15 mg (n = 30); (4) leuprolide acetate (LA) 0.5 mg/day (n = 58); (5) single half-dose LA depot 1.88 mg (n = 49). Cetrorelix was administered daily from menstrual day 8 until the day of human chorionic gonadotropin administration. LA or LA depot was started on day 21 of the previous menstrual cycle. RESULTS: We observed lower gonadotropin (Gn) dosages, estradiol (E2) levels and reduced risk of ovarian hyperstimulation syndrome (OHSS) in the GnRH antagonist groups. A higher risk of luteinizing hormone (LH) surge was noted in cetrorelix 0.2 and 0.15 mg groups. Gn dosages (IU)/E2 levels (pg/mL) in each group were: (1) 1,949.4/1,191.1; (2) 1,869.6/1,010.8; (3) 1,856.7/1,023.6; (4) 2,184.5/1,323.6; and (5) 2,103.5/1,313.5, respectively. LH/OHSS risks were: (1) 3.5%/5.8%; (2) 7.1%/3.6%; (3) 13.3%/3.3%; (4) 3.4%/8.6%; and (5) 2%/8.2%, respectively. Number of oocytes/embryos/grade I, II embryos were: (1) 9.4/7.9/5.8; (2) 7.5/4.2/3.6; (3) 6.3/4.1/3.1; (4) 12.3/8.9/6.6; and (5) 11.8/8.4/6.1, respectively. There was no significant difference in terms of clinical outcomes between groups 1, 4 and 5, except for higher abortion rates (AR) in group 1. Pregnancy rate (PR)/implantation rate (IR) ratios in groups 1, 4, and 5 were statistically higher than those in groups 2 and 3. Chemical PR/IR/AR were: (1) 30.2%/5.9%/7%; (2) 21.4%/5.1%/7.1%; (3) 16.7%/4.1%/10%; (4) 32.8%/5.5%/8.6%; and (5) 30.6%/5.7%/8.2%, respectively. CONCLUSION: The lowest effective dosage of cetrorelix for pituitary desensitization during COH luteolysis is 0.25 mg, resulting in a comparable PR but a higher AR when compared with GnRH agonist. SN - 1875-6263 UR - https://www.unboundmedicine.com/medline/citation/18400585/Comparisons_of_different_dosages_of_gonadotropin_releasing_hormone__GnRH__antagonist_short_acting_form_and_single_half_dose_long_acting_form_of_GnRH_agonist_during_controlled_ovarian_hyperstimulation_and_in_vitro_fertilization_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1028-4559(08)60057-1 DB - PRIME DP - Unbound Medicine ER -