title: The Impact of Pituitary Blockage with GnRH Antagonist and Gonadotrophin Stimulation Length on The Outcome of ICSI Cycles in Women Older than 36 Years.
abstract: The objective of this retrospective cohort study was to evaluate whether the length of pituitary blockage with gonadotrophin-releasing hormone (GnRH) antagonists or the stimulation period influence intracytoplasmic sperm injection (ICSI) outcomes in patients older than 36 years of age.
  
  
  
  In this retrospective study, a total of 138 couples with maternal age >36 years undergoing ICSI with an antagonist protocol were included. The influences of stimulation and suppression length on the response to ovarian stimulation and ICSI outcomes were investigated. Receiver operating characteristic curve (ROC) analysis was performed to assess the predictive value of the stimulation period for achievement of implantation and pregnancy.
  
  
  
  THE GONADOTROPHIN STIMULATION LENGTH NEGATIVELY INFLUENCED THE IMPLANTATION RATE (RC: -4.200; p=0.023). The area under ROC curve (AUC) could distinguish between women with positive and negative implantation (AUC: 0.611; CI: 0.546-0.673) and pregnancy (AUC: 0.593; CI: 0.528-0.656). The threshold value demonstrated a high negative predictive value on likelihood of implantation (p=0.0032, 90% sensitivity) and pregnancy (p=0.0147, 87.1% sensitivity) when patients underwent more than 10 days of stimulation.
  
  
  
  The stimulation period negatively influences the implantation rate in women older than 36 years. A stimulation interval greater than 10 days is associated with a negative predictive value for the chance of implantation and pregnancy.
authors.affiliation: Fertility-Assisted Fertilization Center, Av. Brigadeiro Luis Antônio, São Paulo, SP, Brazil.
authors.forename: Rosane
authors.initials: R
authors.lastname: Santana
authors.affiliation: Fertility-Assisted Fertilization Center, Av. Brigadeiro Luis Antônio, São Paulo, SP, Brazil ; Sapientiae Institute-Educational and Research Center in Assisted Reproduction, Rua Vieira Maciel, São Paulo, SP, Brazil.
authors.forename: Amanda Souza
authors.initials: AS
authors.lastname: Setti
authors.affiliation: Fertility-Assisted Fertilization Center, Av. Brigadeiro Luis Antônio, São Paulo, SP, Brazil.
authors.forename: Luiz Guilherme
authors.initials: LG
authors.lastname: Maldonado
authors.affiliation: Fertility-Assisted Fertilization Center, Av. Brigadeiro Luis Antônio, São Paulo, SP, Brazil.
authors.forename: Fernanda Montenegro
authors.initials: FM
authors.lastname: Valente
authors.affiliation: Fertility-Assisted Fertilization Center, Av. Brigadeiro Luis Antônio, São Paulo, SP, Brazil.
authors.forename: Carla
authors.initials: C
authors.lastname: Iaconelli
authors.affiliation: Fertility-Assisted Fertilization Center, Av. Brigadeiro Luis Antônio, São Paulo, SP, Brazil ; Sapientiae Institute-Educational and Research Center in Assisted Reproduction, Rua Vieira Maciel, São Paulo, SP, Brazil.
authors.forename: Assumpto
authors.initials: A
authors.lastname: Iaconelli
authors.affiliation: Fertility-Assisted Fertilization Center, Av. Brigadeiro Luis Antônio, São Paulo, SP, Brazil ; Sapientiae Institute-Educational and Research Center in Assisted Reproduction, Rua Vieira Maciel, São Paulo, SP, Brazil.
authors.forename: Edson
authors.initials: E
authors.lastname: Borges
keywords: Gonadotrophins; Implantation; Intracytoplasmic Sperm Injection
references.citation: Trends Endocrinol Metab. 2003 Aug;14(6):267-73
references.pmid: 12890591
references.citation: Hum Reprod. 1994 May;9(5):788-91
references.pmid: 7929723
references.citation: Hum Reprod. 1995 Aug;10(8):1974-81
references.pmid: 8567825
references.citation: Fertil Steril. 2011 Feb;95(2):558-62
references.pmid: 20637457
references.citation: Hum Reprod. 2000 Oct;15(10):2145-7
references.pmid: 11006188
references.citation: Proc Natl Acad Sci U S A. 2002 Jan 22;99(2):961-5
references.pmid: 11805337
references.citation: Fertil Steril. 2007 Feb;87(2):241-9
references.pmid: 17113088
references.citation: Biol Reprod. 2005 Jan;72(1):107-18
references.pmid: 15371272
references.citation: Hum Reprod. 1999 Dec;14(12):2959-62
references.pmid: 10601078
references.citation: Fertil Steril. 2000 Feb;73(2):314-20
references.pmid: 10685535
references.citation: Int J Fertil Steril. 2011 Oct;5(3):134-41
references.pmid: 25101156
references.citation: Fertil Steril. 2005 Sep;84(3):802-4
references.pmid: 16169431
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: Eur J Obstet Gynecol Reprod Biol. 2001 Aug;97(2):202-7
references.pmid: 11451549
references.citation: Hum Reprod. 1995 Jun;10(6):1382-6
references.pmid: 7593501
references.citation: Hum Reprod. 2005 Mar;20(3):616-21
references.pmid: 15608037
references.citation: Fertil Steril. 2004 Mar;81(3):562-6
references.pmid: 15037403
references.citation: J Assist Reprod Genet. 1998 Aug;15(7):427-30
references.pmid: 9717118
references.citation: Fertil Steril. 2005 Jul;84(1):108-17
references.pmid: 16009165
references.citation: Hum Reprod. 2004 Aug;19(8):1713-8
references.pmid: 15229205
references.citation: Hum Reprod. 2000 Jul;15(7):1490-8
references.pmid: 10875855
references.citation: Fertil Steril. 2005 Aug;84(2):402-6
references.pmid: 16084881
references.citation: Hum Reprod Update. 2002 Nov-Dec;8(6):543-57
references.pmid: 12498424
references.citation: Reprod Biomed Online. 2006 Nov;13(5):645-50
references.pmid: 17169173
references.citation: Fertil Steril. 2003 Apr;79(4):873-80
references.pmid: 12749423
references.citation: Hum Reprod. 2002 Nov;17(11):2842-5
references.pmid: 12407036
references.citation: Hum Reprod. 2002 Jun;17(6):1643-8
references.pmid: 12042292
references.citation: Hum Reprod Update. 2006 Nov-Dec;12(6):651-71
references.pmid: 16920869
references.citation: Fertil Steril. 2001 Jan;75(1):38-45
references.pmid: 11163814
references.citation: Fertil Steril. 2008 Jun;89(6):1694-701
references.pmid: 18440515
references.citation: Hum Reprod. 2003 Nov;18(11):2257-63
references.pmid: 14585870
references.citation: Hum Reprod. 2002 Aug;17(8):2003-8
references.pmid: 12151428
references.citation: Proc Natl Acad Sci U S A. 2001 Feb 13;98(4):1829-34
references.pmid: 11172036
references.citation: Fertil Steril. 2005 Feb;83(2):331-5
references.pmid: 15705370
references.citation: Fertil Steril. 2009 May;91(5):1842-7
references.pmid: 18501900
references.citation: Aust N Z J Obstet Gynaecol. 1984 May;24(2):121-4
references.pmid: 6437386
references.citation: Reprod Biomed Online. 2007 May;14(5):640-9
references.pmid: 17509210