title: The correlation between follicular fluid pregnancy-associated plasma protein A levels, fertilization, and embryo quality in GnRH agonist and GnRH antagonist protocols in ART cycles.
abstract: BACKGROUND
  Determination of oocyte fertilization and embryo quality are one of the most important purposes in ART cycles. Follicular fluid provides an important microenvironment for development of oocytes and some biochemical characteristics of the follicular fluid, such as pregnancy-associated plasma protein-A (PAPP-A), may play an important role in prediction of success rate of ART.
  
  
  OBJECTIVE
  This study was performed to evaluate whether there was any difference in follicular fluid PAPP-A, fertilization, and embryo quality between GnRH agonist long protocol and flexible GnRH antagonist multiple-dose protocol in ART cycles.
  
  
  METHODS
  A total of 100 women who were candidates for ART were enrolled the study and were divided into two groups, GnRH agonist (GnRHa) long protocol (n=51) and flexible GnRH antagonist (GnRHant) multiple-dose protocol (n=49). Follicular fluid sample was obtained from a single mature follicle and follicular fluid PAPP-A level, fertilization and embryo quality of the same oocyte were evaluated in both groups.
  
  
  RESULTS
  There was no significant difference in the mean levels of follicular fluid PAPP-A between the GnRHa protocol and GnRHant protocol (3.5±1.4 vs. 3.8±1.9, respectively). The mean levels of follicular fluid PAPP-A in fertilized oocyte and good quality embryo were comparable in GnRHa and GnRHant protocols.
  
  
  CONCLUSIONS
  Our data indicated that no differences of follicular fluid PAPP-A levels were observed between cycles using GnRHa long protocol and those of using flexible GnRHant multiple-dose protocol.
authors.affiliation: Department of Obstetrics and Gynecology, Research and Clinical Center for Infertility, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
authors.forename: Razieh
authors.initials: R
authors.lastname: Dehghani Firouzabadi
authors.affiliation: Department of Obstetrics and Gynecology, Zanjan University of Medical Sciences, Zanjan, Iran.
authors.forename: Farnaz
authors.initials: F
authors.lastname: Mohammadian
authors.affiliation: Department of Obstetrics and Gynecology, Arak University of Medical Sciences, Arak, Iran.
authors.forename: Mehri
authors.initials: M
authors.lastname: Mashayekhy
authors.affiliation: Department of Obstetrics and Gynecology, Research and Clinical Center for Infertility, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
authors.forename: Robab
authors.initials: R
authors.lastname: Davar
authors.affiliation: Department of Obstetrics and Gynecology, Research and Clinical Center for Infertility, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
authors.forename: Maryam
authors.initials: M
authors.lastname: Eftekhar
keywords: Assisted reproductive technology; Follicular fluid; GnRH agonist; GnRH antagonist; Pregnancy-associated plasma protein A