GnRH antagonists in IVF.
The present review summarizes existing knowledge on the use of gonadotropin releasing hormone (GnRH) antagonists based on experience gathered after the completion of phase III comparative trials with GnRH agonists. Available data suggest that prolongation of the follicular phase significantly decreases the probability of pregnancy. Moreover, patients with elevated progesterone at initiation of stimulation have significantly fewer chances of achieving an ongoing pregnancy. Luteal support remains mandatory, while the replacement of human chorionic gonadotrophin by GnRH agonist does not appear to be feasible. Although not conclusive, existing data are not in favour of increasing the starting dose of gonadotrophins, of LH supplementation or of using a flexible antagonist protocol.
Kolibianakis
Efstratios M
EM
Unit for Human Reproduction, 1st Department of Obstetrics and Gynaecology, Aristotle University, Thessaloniki, Greece. Stratis.Kolibianakis@otenet.gr
Tarlatzis
Basil
B
Devroey
Paul
P
D004305:Dose-Response Relationship, Drug; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods*; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists / Q000037:antagonists & inhibitors*; D006062:Gonadotropins / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D008183:Luteal Phase / Q000187:drug effects; D007986:Luteinizing Hormone / Q000627:therapeutic use; D015201:Meta-Analysis as Topic; D009865:Oocytes / Q000187:drug effects / Q000502:physiology; D010062:Ovulation Induction / Q000379:methods*; D011247:Pregnancy; D011374:Progesterone / Q000378:metabolism
D006062:Gonadotropins; D007987:Gonadotropin-Releasing Hormone; D011374:Progesterone; D007986:Luteinizing Hormone