title: Comparison of follicular fluid IGF-I, IGF-II, IGFBP-3, IGFBP-4 and PAPP-A concentrations and their ratios between GnRH agonist and GnRH antagonist protocols for controlled ovarian stimulation in IVF-embryo transfer patients.
abstract: BACKGROUND
  Insulin-like growth factors (IGF) and their binding proteins (IGFBP) play a major role in the autocrine and paracrine regulation of folliculogenesis. This is the first study that has compared follicular fluid (FF) IGF-I, IGF-II, IGFBP-3, IGFBP-4 and pregnancy-associated plasma protein (PAPP)-A concentrations, and their ratios, to investigate whether there was any difference in the intrafollicular microenvironment between the GnRH agonist (GnRHa) and antagonist (GnRHant) protocols for controlled ovarian stimulation (COS).
  
  
  METHODS
  A total of 68 IVF cycles were included in this study; two groups were studied: GnRHa long protocol group (n = 36) and the flexible GnRHant multiple-dose protocol group (n = 32). FF was obtained from dominant follicles during oocyte retrieval and stored at -70 degrees C until assayed. IGF-I, IGF-II and IGFBP-3 concentrations were measured by radioimmunoassay and IGFBP-4 and PAPP-A by enzyme-linked immunosorbent assay.
  
  
  RESULTS
  The duration of COS was significantly longer, and total dose of gonadotrophins used, serum estradiol (E(2)) levels on hCG day and the number of oocytes retrieved were significantly higher in the GnRHa long protocol group. The concentrations of FF IGF-II and IGFBP-4 were significantly higher, and the ratio of IGF-I/IGFBP-4 was significantly lower in the GnRHa long protocol group. Serum E(2) levels per mature follicle were not different between the two groups.
  
  
  CONCLUSIONS
  Our data may indicate a difference of intrafollicular microenvironment between cycles using GnRHa long protocols and those using GnRHant protocols. However, the difference in microenvironment does not appear to result in a difference in clinical outcome.
authors.affiliation: Department of Obstetrics and Gynecology, College of Medicine, Seoul National University, Korea.
authors.forename: Young Sik
authors.initials: YS
authors.lastname: Choi
authors.forename: Seung-Yup
authors.initials: SY
authors.lastname: Ku
authors.forename: Byung-Chul
authors.initials: BC
authors.lastname: Jee
authors.forename: Chang-Suk
authors.initials: CS
authors.lastname: Suh
authors.forename: Young Min
authors.initials: YM
authors.lastname: Choi
authors.forename: Jung Gu
authors.initials: JG
authors.lastname: Kim
authors.forename: Shin Yong
authors.initials: SY
authors.lastname: Moon
authors.forename: Seok Hyun
authors.initials: SH
authors.lastname: Kim
mesh_terms: D000328:Adult; D004624:Embryo Transfer; D004797:Enzyme-Linked Immunosorbent Assay; D004958:Estradiol / Q000097:blood; D005260:Female; D005307:Fertilization in Vitro; D015571:Follicular Fluid / Q000737:chemistry*; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists* / Q000031:analogs & derivatives / Q000037:antagonists & inhibitors* / Q000627:therapeutic use; D006801:Humans; D018972:Insulin-Like Growth Factor Binding Protein 3 / Q000032:analysis*; D018974:Insulin-Like Growth Factor Binding Protein 4 / Q000032:analysis*; D007334:Insulin-Like Growth Factor I / Q000032:analysis*; D007335:Insulin-Like Growth Factor II / Q000032:analysis*; D010062:Ovulation Induction / Q000379:methods*; D011247:Pregnancy; D018873:Pregnancy Rate; D011266:Pregnancy-Associated Plasma Protein-A / Q000032:analysis*; D011863:Radioimmunoassay; D017329:Triptorelin Pamoate / Q000627:therapeutic use
chemical_list: D018972:Insulin-Like Growth Factor Binding Protein 3; D018974:Insulin-Like Growth Factor Binding Protein 4; D017329:Triptorelin Pamoate; D007987:Gonadotropin-Releasing Hormone; D004958:Estradiol; D007334:Insulin-Like Growth Factor I; D007335:Insulin-Like Growth Factor II; D011266:Pregnancy-Associated Plasma Protein-A; C062876:cetrorelix