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GnRH agonist versus GnRH antagonist in ovarian stimulation: the role of elevated peak serum progesterone levels.
Gynecol Endocrinol. 2013 Sep; 29(9):843-5.GE

Abstract

AIM

We sought to evaluate the influence of subtle serum progesterone elevation on in vitro fertilization (IVF) cycle outcome and to assess the impact of the type of gonadotropin-releasing hormone (GnRH)-analogue used during controlled ovarian hyperstimulation (COH) on the probability of clinical pregnancy.

PATIENTS AND METHODS

We reviewed the files of all consecutive patients undergoing COH with either GnRH-agonist or antagonist in our IVF unit during a 10-year period and who had their peak serum progesterone levels determined on the day of human chorionic gonadotropin (hCG) administration.

RESULTS

Of the 2244 IVF cycles evaluated, 2103 had peak progesterone level of <1.5 ng/mL (normal-P group) and 141 of >1.5 ng/mL (high-P group) (6.28% of all the study population). Clinical pregnancy rate was significantly higher in the normal-P group (25.4% versus 16.6%; p < 0.006). Moreover, among the high-P group patients, the use of the long GnRH-agonist suppressive protocol (GnRH-ag) was more prevalent in patients who conceived as compared to those who did not (60.9% versus 39%, respectively; p < 0.05), with a tendency toward an increase pregnancy rate in those using GnRH-ag compared with GnRH-antagonist protocol (GnRH-antag; p < 0.059) COH protocols.

CONCLUSION

While subtle progesterone elevation in patients undergoing COH using GnRH-antag COH protocols, should dictate embryo cryopreservation and cancelation of the fresh transfer, in those undergoing the GnRH-ag COH protocol, a fresh embryo transfer should be recommended.

Authors+Show Affiliations

Department of Obstetrics and Gynecology, Barzilai Medical Center, Ashkelon 78278, Israel. raoul.orvieto@sheba.health.gov.ilNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

23802563

Citation

Orvieto, Raoul, et al. "GnRH Agonist Versus GnRH Antagonist in Ovarian Stimulation: the Role of Elevated Peak Serum Progesterone Levels." Gynecological Endocrinology : the Official Journal of the International Society of Gynecological Endocrinology, vol. 29, no. 9, 2013, pp. 843-5.
Orvieto R, Nahum R, Meltzer S, et al. GnRH agonist versus GnRH antagonist in ovarian stimulation: the role of elevated peak serum progesterone levels. Gynecol Endocrinol. 2013;29(9):843-5.
Orvieto, R., Nahum, R., Meltzer, S., Liberty, G., Anteby, E. Y., & Zohav, E. (2013). GnRH agonist versus GnRH antagonist in ovarian stimulation: the role of elevated peak serum progesterone levels. Gynecological Endocrinology : the Official Journal of the International Society of Gynecological Endocrinology, 29(9), 843-5. https://doi.org/10.3109/09513590.2013.808328
Orvieto R, et al. GnRH Agonist Versus GnRH Antagonist in Ovarian Stimulation: the Role of Elevated Peak Serum Progesterone Levels. Gynecol Endocrinol. 2013;29(9):843-5. PubMed PMID: 23802563.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - GnRH agonist versus GnRH antagonist in ovarian stimulation: the role of elevated peak serum progesterone levels. AU - Orvieto,Raoul, AU - Nahum,Ravit, AU - Meltzer,Simion, AU - Liberty,Gadi, AU - Anteby,Eyal Y, AU - Zohav,Efraim, Y1 - 2013/06/26/ PY - 2013/6/28/entrez PY - 2013/6/28/pubmed PY - 2014/4/1/medline SP - 843 EP - 5 JF - Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology JO - Gynecol Endocrinol VL - 29 IS - 9 N2 - AIM: We sought to evaluate the influence of subtle serum progesterone elevation on in vitro fertilization (IVF) cycle outcome and to assess the impact of the type of gonadotropin-releasing hormone (GnRH)-analogue used during controlled ovarian hyperstimulation (COH) on the probability of clinical pregnancy. PATIENTS AND METHODS: We reviewed the files of all consecutive patients undergoing COH with either GnRH-agonist or antagonist in our IVF unit during a 10-year period and who had their peak serum progesterone levels determined on the day of human chorionic gonadotropin (hCG) administration. RESULTS: Of the 2244 IVF cycles evaluated, 2103 had peak progesterone level of <1.5 ng/mL (normal-P group) and 141 of >1.5 ng/mL (high-P group) (6.28% of all the study population). Clinical pregnancy rate was significantly higher in the normal-P group (25.4% versus 16.6%; p < 0.006). Moreover, among the high-P group patients, the use of the long GnRH-agonist suppressive protocol (GnRH-ag) was more prevalent in patients who conceived as compared to those who did not (60.9% versus 39%, respectively; p < 0.05), with a tendency toward an increase pregnancy rate in those using GnRH-ag compared with GnRH-antagonist protocol (GnRH-antag; p < 0.059) COH protocols. CONCLUSION: While subtle progesterone elevation in patients undergoing COH using GnRH-antag COH protocols, should dictate embryo cryopreservation and cancelation of the fresh transfer, in those undergoing the GnRH-ag COH protocol, a fresh embryo transfer should be recommended. SN - 1473-0766 UR - https://www.unboundmedicine.com/medline/citation/23802563/GnRH_agonist_versus_GnRH_antagonist_in_ovarian_stimulation:_the_role_of_elevated_peak_serum_progesterone_levels_ L2 - https://www.tandfonline.com/doi/full/10.3109/09513590.2013.808328 DB - PRIME DP - Unbound Medicine ER -