Skip to main content

Comparing GnRH agonist long protocol and gnrh antagonist protocol in outcome the first cycle of ART

Archives of Gynecology and Obstetrics volume 281, pages 81–85 (2010)Cite this article

Abstract

Purpose

This prospective study evaluated the efficacy of gonadotropin-releasing hormone (GnRH) antagonist protocol in comparison with the GnRH agonist protocol in the first cycle of assisted reproductive technique (ART).

Methods

We randomized 235 patients undergoing ART for the first time. The first group was stimulated with a standard long protocol and the second group stimulated with GnRH antagonis.

Results

There was no statistically significant difference in the age, infertility cause, basal FSH, BMI, the number of oocytes retrieved, number of M2 oocytes, embryo obtained and endometrial thickness between the two groups. But Serum estradiol, consumption of gonadotropins and ovarian hyperstimulation syndrome were significantly lower in the antagonist protocol. Cancellation rate of embryo transfer due to poor-quality embryo in the antagonist protocol was higher, but it was not significant. There was no significant difference in the clinical pregnancy and ongoing pregnancy between the two groups.

Conclusion

GnRH-antagonist is an effective, safe, and well-tolerated alternative to agonist in the first cycle of ART.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price includes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1

References

  1. Edward RG, Steptoe PC, Purdy JM (1980) Establishing full term human pregnancies using cleaving embryos grown in vitro. Br J Obstet Gynaecol 87:737–756

    Google Scholar 

  2. Howel CM, Macnamee MC, Edwards RG et al (1986) Effects of high tonic levels of luteinizing hormone on outcome of IVF. Lancet 2:521

    Google Scholar 

  3. Fleming R, Couttes JR (1986) Introduction of multiple follicular growth in normally menstruating women with endogenous gonadotropin suppression. Fertil Steril 45:3–226

    Google Scholar 

  4. Olivennes F, Cunha-Filho JS, Fanchin R et al (2002) The use of GnRH antagonist in ovarian stimulation. Hum Reprod Update 8:279–290

    Article  CAS  PubMed  Google Scholar 

  5. AI-Inany H, Aboulghar M (2002) GnRH antagonist in assisted conception: a Cochrane Review. Hum Reprod 17:874–885

    Article  Google Scholar 

  6. Marologlu O, Kilic S, Karalycin R et al (2008) Comparison of GnRH agonists and antagonists in normoresponder IVF/ICSI in Turkish female patients. Adv Ther 25(3):266–267

    Article  CAS  Google Scholar 

  7. Felberbaun RE, Albano C, Ludwig M et al (2000) European Cetrorelix Study Group Ovarian stimulation for assisted reproduction with HMG and concomitant midcycle administration of the GnRH antagonist cetrorelix according to the multiple dose protocol: a prospective uncontrolled phase III study. Hum Reprod 15:1015–1020

    Article  Google Scholar 

  8. The European and Middle East Orgalutran Study Group (2001) Comparable clinical outcomes using the GnRH agonist Triptorelin for the prevention of premature LH surges in women undergoing ovarian stimulation. Hum Reprod 16:644–651

    Article  Google Scholar 

  9. The North American Ganirelix study Group (2001) Efficacy and safety of ganirelix acetate versus leuprolide acetate in women undergoing controlled ovarian hyperstimulation. Fertil Steril 75:38–45

    Article  Google Scholar 

  10. Ludwig M, Felberbaum RE, Devroey P et al (2000) Significant reduction of the incidence of ovarian hyperstimulation syndrome by using the LHRH antagonist cetrorelix in controlled ovarian stimulation for assisted reproduction. Arch Gynecol Obstet 264:29–32

    Article  CAS  PubMed  Google Scholar 

  11. Albano C, Felberbaum RE, Smithz J et al (2000) Ovarian stimulation with HMG: results of a prospective randomized phase III European study comparing the luteinizing hormone–releasing hormone (LHRH)-antagonist cetrorelix and the LHRH-agonist buserlin. Hum Reprod 15:526–531

    Article  CAS  PubMed  Google Scholar 

  12. Kolibianakis EM, Collins J, Tarlatzis B et al (2006) Are endogenous LH levels during ovarian stimulation for IVF using GnRH analogues associated with the probability of ongoing pregnancy? A systemic review. Hum Reprod Update 12:325–326

    Article  Google Scholar 

  13. Newton C, Solta D, Yuzpe AA, Tummon IS (1996) Memory complaints associated with the use of gonadotropin- releasing hormone agonists: a preliminary study. Fertil Steril 65:1253–1255

    CAS  PubMed  Google Scholar 

  14. Tarlatziz BC, Fauser BC, Kolibianakis EM et al (2006) GnRH antagonist in ovarian stimulation for IVF. Hum Reprod Update 12:333–340

    Google Scholar 

  15. GnRH—analog in cancer and Human Reproduction, A100. Deutsches IVF Register 2003. Annual report from the German IVF Registry 2003 (http://www.Deutsches-ivf-register.de)

  16. Akman MA, Erden HF, Tosun SB et al (2000) Addition of GnRH antagonist in cycles of poor responders undergoing IVF. Hum Reprod 15:2145–2147

    Article  CAS  PubMed  Google Scholar 

  17. Akman MA, Erden HF, Tosun SB et al (2001) Comparison of agonist flare up protocol and antagonistic multiple dose protocol in ovarian stimulation of poor responders: results of a prospective randomized trial. Hum Reprod 16:868–870

    Article  CAS  PubMed  Google Scholar 

  18. Aboulghar MA, Mansour RT, Serour GI et al (2004) Increasing the dose of human menopausal gonadotropins on the day of GnRH antagonist administration: randomized controlled trial. Reprod Biomed Online 8:524–527

    CAS  PubMed  Article  Google Scholar 

  19. Cedrin-Durnerin I, Grange -Dujardin D, Laffy A et al (2004) Recombinant human LH supplementation during GnRH antagonist administration in IVF/ICSI cycles: A prospective randomized study. Hum Reprod 19:1979–1984

    Article  CAS  PubMed  Google Scholar 

  20. Giorgetti C, Terriou P, Auquier P et al (1995) Embryo score to predict implantation after in vitro fertilization based on 957 single embryo transfers. Hum Reprod 10:2427–2431

    CAS  PubMed  Google Scholar 

  21. Van Royen E, Mangelschots K, De Neubourg D et al (1999) Characterization of a top quality embryo, a step towards single embryo transfer. Hum Reprod 14:2345–2349

    Article  PubMed  Google Scholar 

  22. Practice Committee of the Society for Assisted Reproductive Technology (2006) Practice Committee of the American Society for Reproductive Medicine. Guidelines on number of embryos transferred. Fertil Steril 86(5 suppl):51–52

    Google Scholar 

  23. Xavier P, Camboa C, Calejo L et al (2005) A randomized s tudy of GnRH antagonist versus agonist for ovarian stimulation. Eur J Obstet Gynecol Reprod Biol 120:185–189

    Article  CAS  PubMed  Google Scholar 

  24. Tazequl A, Gorkemli H, Ozdemir S et al (2008) Comparison of multiple dose GnRH antagonist and minidose long agonist protocol in poor responders undergoing invitro fertilization: a randomized controlled trial. Arch Gynecol Obstet 278:467–472

    Google Scholar 

  25. Li Y, Li Y, Lao O et al (2008) Comparison between a GnRH agonist and GnRH antagonist protocol for the same patient undergoing IVF. J Huazhong Univ Sci Tech Med Sci 28:618–620

    Google Scholar 

  26. Orvieto R, Rabinson J, Meltzer S et al (2006) GnRH agonist versus GnRH antagonist in ovarian stimulation: is the improper naker? Clin Exp Obstet Gynechol 33:197–199

    CAS  Google Scholar 

  27. Sirayapiwat P, Suwajanakorn S, Triratanachat S et al (2007) The effect of GnRH antagonist on the endometrium of normally menstruating women. J Assist Reprod Genet 24:579–586

    Article  PubMed  Google Scholar 

  28. Fluker M, Grifo J, Leader A (2001) Efficacy and safety of Ganirelix acetate versus leuprolide in women undergoing controlled ovarian stimulation. Fertil Steril 75:38–45

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The authors are grateful to the patients who participate in this study, the infertility nurses and embryology staff of the Research and Clinical Center for Infertility.

Author information

Authors and Affiliations

  1. Fellowship of Infertility, Department of Obstetrics and Gynecology, Research and Clinical Center for Infertility, Shahid Sadoughi University of Medical Science, 8916877391, Yazd, Iran

    Razieh Dehghani Firouzabadi, Shahnaz Ahmadi, Homa Oskouian & Robab Davar

Authors
  1. Razieh Dehghani Firouzabadi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shahnaz Ahmadi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Homa Oskouian
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Robab Davar
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shahnaz Ahmadi.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Firouzabadi, R.D., Ahmadi, S., Oskouian, H. et al. Comparing GnRH agonist long protocol and gnrh antagonist protocol in outcome the first cycle of ART. Arch Gynecol Obstet 281, 81–85 (2010). https://doi.org/10.1007/s00404-009-1073-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-009-1073-5

Keywords

  • GnRH antagonist
  • GnRH agonist
  • Pregnancy rate
  • Assisted reproductive technology
  • Ovarian stimulation