Early and short follicular gonadotropin-releasing hormone antagonist supplementation improves the meiotic status and competence of retrieved oocytes in in vitro fertilization-embryo transfer cycles.
OBJECTIVE
To investigate whether early and short follicular administration of GnRH antagonist using the flexible protocol has the potential to improve IVF-ET clinical results.


METHODS
Prospective, controlled, randomized study.


METHODS
University-affiliated assisted reproductive technology unit.


METHODS
Fifty-three consecutive infertile women were enrolled to the study and control groups.


METHODS
Both groups were treated with recombinant FSH and the flexible GnRH antagonist protocol. Women in the study group were additionally supplemented with three injections of GnRH antagonist (0.25 mg/d on days 1, 2, and 3 of the menstrual cycle).


METHODS
Hormonal milieu, oocyte meiotic status, competence for normal fertilization, cleavage, and clinical pregnancy rate.


RESULTS
Both groups had comparable baseline characteristics. The duration of recombinant FSH treatment was significantly longer in the study group as compared with the control group (10.9+/-3.1 and 9.7+/-1.3 days, respectively). The number of follicles>or=14 mm and E2 level on the day of hCG administration, number of retrieved oocytes, and endometrial thickness were similar between the two groups. However, the fertilization rate was significantly higher in the study as compared with the control group (85%+/-16% and 69%+/-24%, respectively). Moreover, the cumulative rate of mature first polar body oocytes was significantly higher in the study group as compared with the control group (93% and 85%, respectively). Concomitantly, day-3 FSH and LH levels after initiation of treatment were significantly lower in the study as compared with the control group (6.1+/-2.4 mIU/mL vs. 7.2+/-1.9 mIU/mL and 2.4+/-1.6 mIU/mL vs. 5.6+/-2.7 mIU/mL, respectively).


CONCLUSIONS
Early and short follicular GnRH antagonist supplementation using flexible GnRH antagonist treatment improves the meiotic status and competence of retrieved oocytes. It seems that early and short pituitary shutdown has the potential to improve clinical results in IVF-ET GnRH antagonist cycles.
Reproductive Medicine Unit, Department of Obstetrics and Gynecology, Poriya Medical Center, Tiberias, Israel; The Bruce Rappaport Faculty of Medicine, The Technion, Haifa, Israel. Electronic address: jsy@netvision.net.il.
Johnny S
JS
Younis
Reproductive Medicine Unit, Department of Obstetrics and Gynecology, Poriya Medical Center, Tiberias, Israel.
Sofia
S
Soltsman
Department of Evolutionary and Environmental Biology, Haifa University, Haifa, Israel.
Ido
I
Izhaki
Reproductive Medicine Unit, Department of Obstetrics and Gynecology, Poriya Medical Center, Tiberias, Israel.
Orit
O
Radin
Reproductive Medicine Unit, Department of Obstetrics and Gynecology, Poriya Medical Center, Tiberias, Israel.
Shalom
S
Bar-Ami
Reproductive Medicine Unit, Department of Obstetrics and Gynecology, Poriya Medical Center, Tiberias, Israel; The Bruce Rappaport Faculty of Medicine, The Technion, Haifa, Israel.
Moshe
M
Ben-Ami
D000328:Adult; D004334:Drug Administration Schedule; D004624:Embryo Transfer / Q000379:methods; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods; D005498:Follicular Phase / Q000187:drug effects; D007987:Gonadotropin-Releasing Hormone / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000037:antagonists & inhibitors* / Q000494:pharmacology; D006727:Hormone Antagonists / Q000008:administration & dosage / Q000494:pharmacology; D006801:Humans; D008540:Meiosis / Q000187:drug effects*; D054315:Oocyte Retrieval; D009865:Oocytes / Q000166:cytology / Q000187:drug effects*; D011247:Pregnancy; D011786:Quality Control; D013997:Time Factors
D006727:Hormone Antagonists; D007987:Gonadotropin-Releasing Hormone; C061018:ganirelix