title: Optimisation of the follicular phase in IVF/ICSI.
abstract: In reproductive medicine, the aim is to establish an optimal balance between cost-effectiveness, success rate and safety for the patient. In this thesis, a series of clinical studies are presented that all revolve around the optimisation of ovarian stimulation with GnRH antagonist co-treatment. Basal hormonal levels at the start of ovarian stimulation are mandatory to obtain acceptable pregnancy rates. In view of this, we focused on the impact of cycle day 2 progesterone levels on treatment outcome. By interfering in the early follicular phase, we tried to synchronise the follicular cohort and to increase the number of retrieved oocytes. Innovative treatment protocols based on GnRH antagonists should lead to a more flexible and better controlled schedule of oocyte retrievals. The inability to program the start of gonadotrophin stimulation and hence to minimise weekend oocyte retrievals is a major impediment to the widespread implementation of the GnRH antagonist protocol in fertility clinics. Because treatment schedule is important both for the patients, who wish to undergo reproductive treatment at their own convenience, and for the ART clinic, to organise the workload, we attempted to bring the schedule of egg retrievals in a GnRH antagonist protocol under improved control. Another important aim of our clinical research was to diminish patient discomfort and reduce side effects by a simplification of GnRH antagonist ovarian stimulation protocols. We also focused on significant reduction of FSH consumption by substitution of FSH by low dosages of hCG during the mid-late follicular phase, without impairing outcome in terms of oocyte yield and ongoing pregnancy rate or live birth rate.
authors.affiliation: Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium.
authors.forename: C
authors.initials: C
authors.lastname: Blockeel
authors.affiliation: Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium.
authors.forename: P
authors.initials: P
authors.lastname: Devroey
keywords: GnRH antagonist; ICSI; IVF; follicular phase; reproductive endocrinology; scheduling
references.citation: Baillieres Clin Obstet Gynaecol. 1993 Jun;7(2):309-30
references.pmid: 8358893
references.citation: Am J Physiol. 1973 Jan;224(1):170-5
references.pmid: 4566849
references.citation: Cochrane Database Syst Rev. 2011 May 11;(5):CD001750
references.pmid: 21563131
references.citation: Fertil Steril. 2002 Aug;78(2):414-6
references.pmid: 12137883
references.citation: Lancet. 2007 Mar 3;369(9563):743-749
references.pmid: 17336650
references.citation: Hum Reprod Update. 2006 Nov-Dec;12(6):651-71
references.pmid: 16920869
references.citation: Br J Obstet Gynaecol. 1982 Jan;89(1):80-3
references.pmid: 6800399
references.citation: J Clin Endocrinol Metab. 2002 Mar;87(3):1156-61
references.pmid: 11889180
references.citation: Fertil Steril. 2004 Jul;82(1):102-7
references.pmid: 15236997
references.citation: Hum Reprod. 1998 Dec;13(12):3434-40
references.pmid: 9886530
references.citation: Lancet. 1984 Dec 1;2(8414):1284-5
references.pmid: 6150318
references.citation: Mol Hum Reprod. 2011 Jan;17(1):33-41
references.pmid: 20705718
references.citation: Hum Reprod Update. 2006 Jul-Aug;12(4):333-40
references.pmid: 16567347
references.citation: J Clin Endocrinol Metab. 2011 Apr;96(4):1122-8
references.pmid: 21307142
references.citation: Curr Pharm Biotechnol. 2011 Mar 1;12(3):423-8
references.pmid: 21133851
references.citation: Fertil Steril. 2005 Aug;84(2):394-401
references.pmid: 16084880
references.citation: Hum Reprod. 2009 Apr;24(4):764-74
references.pmid: 19153090
references.citation: Cochrane Database Syst Rev. 2006 Jul 19;(3):CD001750
references.pmid: 16855976
references.citation: Fertil Steril. 2006 Oct;86(4):1023-5
references.pmid: 16949587
references.citation: Reprod Biomed Online. 2012 Mar;24(3):272-80
references.pmid: 22296973
references.citation: Endocrinology. 1970 Nov;87(5):850-3
references.pmid: 4991672
references.citation: Fertil Steril. 2008 Oct;90(4):1055-63
references.pmid: 18054003
references.citation: J Clin Endocrinol Metab. 2003 Jan;88(1):166-73
references.pmid: 12519847
references.citation: Hum Reprod. 2005 Nov;20(11):3198-203
references.pmid: 16055454
references.citation: Hum Reprod. 2010 Nov;25(11):2678-84
references.pmid: 20858698
references.citation: Fertil Steril. 2005 May;83(5):1397-403
references.pmid: 15866575
references.citation: Hum Reprod Update. 2004 Jul-Aug;10(4):309-16
references.pmid: 15192058
references.citation: Gynecol Obstet Invest. 2007;64(3):156-60
references.pmid: 17934312
references.citation: Hum Reprod. 2005 Jun;20(6):1541-7
references.pmid: 15705618
references.citation: Fertil Steril. 2010 Nov;94(6):2382-4
references.pmid: 20537631
references.citation: Hum Reprod. 2009 Nov;24(11):2910-6
references.pmid: 19617207
references.citation: Fertil Steril. 2011 Apr;95(5):1714-9.e1-2
references.pmid: 21300334