title: Precycle administration of GnRH antagonist and microdose HCG decreases clinical pregnancy rates without affecting embryo quality and blastulation.
abstract: The outcome of a novel protocol utilizing precycle gonadotrophin-releasing hormone (GnRH) antagonist administration and LH activity support with microdose recombinant human chorionic gonadotrophin (HCG) was compared to GnRH agonist long protocol used in patients undergoing their first ICSI (n=707) or IVF (n=571) cycles, which had resulted in one or two blastocyst transfers. In GnRH antagonist cycles, cetrorelix acetate (3 mg) was administered s.c. 4 days before FSH stimulation and a repeat dose was given when the lead follicular diameter was 13-14 mm. LH support was provided by recombinant HCG (2.5 microg). Embryo progression and blastulation were evaluated using embryo progression indices and blastocyst quality scores. The tested protocol demonstrated reduced implantation and clinical pregnancy rates as compared with GnRH agonist long protocol, although the embryo progression and blastulation parameters and blastocyst quality were comparable among the groups. Logistic regression models further supported the significant negative impact of GnRH antagonist/microdose HCG protocol on clinical pregnancy rates in both ICSI and IVF patients. Assisted reproduction cycles with fresh blastocyst transfers utilizing precycle GnRH antagonist administration and microdose HCG support resulted in lower implantation and clinical pregnancy rates as compared with GnRH agonist cycles, although the embryo progression and blastulation parameters were comparable.
authors.affiliation: Centre for Assisted Reproduction, Bedford, Texas, USA. Obukul@parknet.pmh.org
authors.forename: Orhan
authors.initials: O
authors.lastname: Bukulmez
authors.forename: Khurram S
authors.initials: KS
authors.lastname: Rehman
authors.forename: Martin
authors.initials: M
authors.lastname: Langley
authors.forename: Bruce R
authors.initials: BR
authors.lastname: Carr
authors.forename: Anna C
authors.initials: AC
authors.lastname: Nackley
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Doody
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Doody
mesh_terms: D000328:Adult; D001755:Blastocyst / Q000187:drug effects / Q000502:physiology*; D036703:Blastula / Q000187:drug effects / Q000502:physiology*; D006063:Chorionic Gonadotropin / Q000008:administration & dosage*; D004624:Embryo Transfer; D004622:Embryo, Mammalian / Q000187:drug effects / Q000502:physiology; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods; D007987:Gonadotropin-Releasing Hormone / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000037:antagonists & inhibitors*; D006801:Humans; D010062:Ovulation Induction / Q000379:methods*; D011247:Pregnancy; D018873:Pregnancy Rate; D012044:Regression Analysis; D016896:Treatment Outcome
chemical_list: D006063:Chorionic Gonadotropin; D007987:Gonadotropin-Releasing Hormone; C062876:cetrorelix