Altered vascular endothelial growth factor expression during GnRH antagonist protocol in women of reproductive age with normal baseline hormone profiles.
OBJECTIVE
To explain the unexpected low response to GnRH antagonist protocol in reproductive women with normal baseline hormone profiles.


METHODS
Retrospective study.


METHODS
University hospital.


METHODS
Twenty-five women undergoing their first IVF cycle.


METHODS
Follicular fluid (FF) from large follicles (>15 mm) was obtained during oocyte retrieval from unexpected low responders (n = 13, group A) and 12 age-matched normal responders (n = 12, group B).


METHODS
The FF markers known to reflect follicle environment (insulin-like growth factor [IGF] II, IGF-binding protein 4, müllerian-inhibiting substance, pregnancy-associated plasma protein A, soluble Fas, and vascular endothelial growth factor [VEGF]) were analyzed by ELISA.


RESULTS
The baseline characteristics (age, day 3 serum LH, FSH, E(2), duration and dose of r-FSH, GnRH antagonist) were not different between the two groups. The number of large follicles, oocytes retrieved, and serum E(2) levels on the day of hCG injection were significantly higher in group B. Whereas the other follicular markers did not differ between the two groups, VEGF was significantly higher in group A. In addition, the VEGF concentration showed an inverse correlation with the total number of oocytes retrieved.


CONCLUSIONS
The unexpected low response in women with normal basal hormone profiles, during GnRH antagonist protocol, was associated with altered follicular VEGF expression.
Koo
Young-Ah
YA
Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Lee
BoEun
B
Park
Hyun-Jung
HJ
Choi
JongYeob
J
Lee
EunYoung
E
Choi
DooSeok
D
D000328:Adult; D006063:Chorionic Gonadotropin / Q000008:administration & dosage; D004958:Estradiol / Q000097:blood; D005260:Female; D005300:Fertility Agents, Female / Q000008:administration & dosage*; D005307:Fertilization in Vitro; D043373:Follicle Stimulating Hormone, Human / Q000008:administration & dosage / Q000097:blood; D015571:Follicular Fluid / Q000378:metabolism*; D007987:Gonadotropin-Releasing Hormone / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000037:antagonists & inhibitors*; D006727:Hormone Antagonists / Q000008:administration & dosage*; D006728:Hormones / Q000097:blood*; D006801:Humans; D007986:Luteinizing Hormone / Q000097:blood; D054315:Oocyte Retrieval; D010062:Ovulation Induction / Q000379:methods*; D010197:Pancuronium / Q000008:administration & dosage / Q000031:analogs & derivatives; D011247:Pregnancy; D018873:Pregnancy Rate; D011374:Progesterone / Q000097:blood; D012189:Retrospective Studies; D016896:Treatment Outcome; D042461:Vascular Endothelial Growth Factor A / Q000378:metabolism*
D006063:Chorionic Gonadotropin; D005300:Fertility Agents, Female; D043373:Follicle Stimulating Hormone, Human; D006727:Hormone Antagonists; D006728:Hormones; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D007987:Gonadotropin-Releasing Hormone; D011374:Progesterone; D004958:Estradiol; D007986:Luteinizing Hormone; C061018:ganirelix; D010197:Pancuronium; C003549:dacuronium