title: GnRH antagonist improved blastocyst quality and pregnancy outcome after multiple failures of IVF/ICSI-ET with a GnRH agonist protocol.
abstract: BACKGROUND
  To determine the efficacy of a gonadotrophin-releasing hormone (GnRH) antagonist, cetrorelix, in improving the quality of embryos and pregnancy outcome, we performed a study in patients with a history of multiple failures of in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) cycles with a GnRH agonist (GnRHa) long protocol.
  
  
  METHODS
  Forty women with no live births after conventional IVF or ICSI embryo transfer (ET) and subsequent blastocyst transfer (BT) with a GnRHa long protocol entered this study. The treatment protocol consisted of a daily dose of clomiphene citrate 100 mg for 5 days and gonadotrophin injections daily from cycle day 4 onward. Cetrorelix, 0.25 mg/day, was started when the leading follicle reached 14 mm. Induction of ovulation was triggered with human chorionic gonadotrophin (HCG) (N = 36) or GnRHa (N = 4). It was possible to perform BT in 38 patients.
  
  
  RESULTS
  Comparison of the results with the results for BT with the previous GnRHa protocol showed no significant differences in number of oocytes retrieved or the zygote- and blastocyst-development rate. With the cetrorelix protocol, however, number of patients whose embryos had developed to at least one expanded blastocyst on day 5 was significantly higher than with the GnRHa protocol (25 vs. 9) (p < 0.001), and 16 of the women became pregnant (42.1%), with 7 delivering 9 infants, 4 ending in abortion (25%), and 5 in progressing.
  
  
  CONCLUSIONS
  The use of a GnRH antagonist in controlled ovarian hyperstimulation improves the outcome of pregnancy of patients with a history of multiple failure of IVF/ICSI-ET in a GnRHa protocol, most likely due to improvement of the quality of the blastocysts generated.
authors.affiliation: Hiroshima HART Clinic, 5-7-10 Ohtemachi, Naka-ku, Hiroshima 730-0051, Japan. hart@enjoy.ne.jp
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Takahashi
authors.forename: Tetsunori
authors.initials: T
authors.lastname: Mukaida
authors.forename: Tatsuhiro
authors.initials: T
authors.lastname: Tomiyama
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Goto
authors.forename: Chikahiro
authors.initials: C
authors.lastname: Oka
mesh_terms: D000328:Adult; D001755:Blastocyst; D004624:Embryo Transfer; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods*; D007987:Gonadotropin-Releasing Hormone / Q000031:analogs & derivatives* / Q000494:pharmacology*; D006062:Gonadotropins / Q000819:agonists / Q000494:pharmacology / Q000627:therapeutic use; D006727:Hormone Antagonists / Q000494:pharmacology*; D006801:Humans; D011247:Pregnancy; D011256:Pregnancy Outcome; D011786:Quality Control; D020554:Sperm Injections, Intracytoplasmic / Q000379:methods*
chemical_list: D006062:Gonadotropins; D006727:Hormone Antagonists; D007987:Gonadotropin-Releasing Hormone; C062876:cetrorelix