4,525 research outputs found

    Down Regulation with Luteal GnRH Agonist Therapy in Euploid Embryo Transfers Does Not Impact Pregnancy Rates

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    Introduction : Gonadotropin-releasing hormone (GnRH) agonists have been used during assisted reproductive technology (ART) treatment for pituitary suppression and stimulation. Currently, clinical opinion is divided about whether GnRH agonist therapy improves pregnancy rates when used for luteal down-regulation in a frozen euploid embryo transfer (FET). This study evaluated the clinical utility of GnRH agonist down-regulation in single, euploid FET cycles. Methods : A retrospective analysis was performed, using data from patients who underwent a single, euploid FET cycle from 2012 to 2019. Patients were segregated into two cohorts: Group A: single, euploid FET with down-regulation using GnRH agonist; Group B: single, euploid FET without down-regulation using GnRH agonist. Primary outcomes include pregnancy rates among cohorts. Results : Group A demonstrated a pregnancy rate of 72.92% in 96 cycles. Group B demonstrated a pregnancy rate of 73.27% in 5,668 cycles. There was no difference in pregnancy rates between groups, X2(2, N = 5764) = .0061, p = .94. A subgroup of patients (n=5) with endometriosis in Group A achieved an 80% (4/5) pregnancy rate. Discussion : Single, euploid FET cycle pregnancy rates were not affected by the use of down-regulation with a GnRH agonist. Increased pregnancy rates found with prolonged GnRH agonist use in other studies weren’t seen with short term use for FET cycles. Future research should focus on molecular markers and gene transcription signatures to attempt to define whether there is an ideal population of patients who would benefit from GnRH agonist down-regulation prior to FET

    Comparison of antimüllerian hormone levels and antral follicle count as predictor of ovarian response to controlled ovarian stimulation in good-prognosis patients at individual fertility clinics in two multicenter trials

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    Objective To compare antimüllerian hormone (AMH) and antral follicle count (AFC) as predictors of ovarian response to controlled ovarian stimulation at individual fertility clinics. Design Retrospective analysis of individual study center data in two multicenter trials. Centers that provided >10 patients were included in the analysis. Setting A total of 19 (n = 519 patients) and 18 study centers (n = 686 patients) participating in a long GnRH agonist trial (MERIT) and a GnRH antagonist trial (MEGASET), respectively. Patient(s) Infertile women of good prognosis. Intervention(s) Long GnRH agonist or GnRH antagonist cycles. Main Outcome Measure(s) Correlation between AMH and AFC, and oocyte yield by each study center for each trial. Results(s) Antimüllerian hormone was more strongly correlated with oocyte yield than AFC: r = 0.56 vs. r = 0.28 in the GnRH agonist cohort, and r = 0.55 vs. r = 0.33 in the GnRH antagonist cohort. The correlation was numerically higher for AMH than for AFC at a significantly higher proportion of study centers: 17 (89%) and 15 (83%) centers in the long GnRH agonist and GnRH antagonist trial, respectively. Assessment of the relative capacity of AMH and AFC for predicting oocyte yield demonstrated that AMH dominated the model: AMH, R2 = 0.29 and 0.23; AFC: R2 = 0.07 and 0.07; AMH + AFC: R2 = 0.30 and 0.23 for long GnRH agonist and GnRH antagonist trials, respectively. Conclusions(s) Antimüllerian hormone was a stronger predictor of ovarian response to gonadotropin therapy than AFC at the study center level in both randomized trials utilizing GnRH agonist and GnRH antagonist protocols. Antral follicle count provided no added predictive value beyond AMH.</p

    Effects of GnRH agonist treatment on steroidogenesis and folliculogenesis in the ovary of cyclic mice

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    <p>Abstract</p> <p>Background</p> <p>GnRH analogs (both agonist and antagonist) have been extensively used for clinical applications, following the discovery of its direct effects on ovary. With regard to the direct actions of GnRH agonist on ovary, conflicting data are reported. The mechanism through which GnRH agonist affect gonadal functions is still obscure. The aim of present study was thus to investigate the effects of treatment with different doses of GnRH agonist, <it>in vivo and in vitro</it>, on morphological, physiological and functional changes in the ovary of cyclic mice.</p> <p>Methods</p> <p>To find out the effect of GnRH agonist on ovarian activity, cyclic mice were treated with different doses for 8 days and its effect on folliculogenesis (morphological changes in follicle, Estrogen receptor, progesterone receptor), steroidogenesis (circulating progesterone level, StAR, LH-receptor, 3β-HSD), luteinization (Morphology of corpus luteum) and apoptosis (caspase-3, PARP) were observed. To find the in vitro effects of GnRH agonist with or without LH on ovary of mice, changes in the expression of LH-receptor, estrogen receptor, progesterone receptor, 3β-HSD in the ovary and progesterone level in the culture media were investigated.</p> <p>Results</p> <p>GnRH agonist treatment produced significant changes in ovarian mass, circulating steroids level and ovarian follicular development, steroidogenesis and apoptosis in the mice. GnRH agonist also caused dose dependent histological changes in follicular development and luteinization. The mice treated with different doses of GnRH agonist showed biphasic effects on steroid synthesis due to its effects on ovarian expression of LH-receptor, StAR, and 3β -hydroxysteroid dehydrogenase proteins. The high dose showed stimulatory effect, whereas pharmacological dose showed inhibitory effect on ovarian follicular development and steroidogenesis. The <it>in vitro </it>study generally showed inhibitory effects of GnRH agonist on ovarian activities, which may be reversed by the presence of LH.</p> <p>Conclusion</p> <p>Both inhibitory and stimulatory effects found in the present study suggest that GnRH agonist is a versatile tool in the therapy of a variety of gynecological and non-gynecological conditions. This study suggests that the outcome of direct effect of GnRH-ag on ovary depends on LH-responsiveness.</p

    The impact of GnRH-agonist triggers on autologous in vitro fertilization outcomes: A retrospective analysis

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    BACKGROUND: In vitro fertilization in assisted reproduction requires controlled ovarian stimulation with exogenous gonadotrophins and oocyte maturation before ultrasound guided aspiration. GnRH-agonists have been utilized as an alternative to hCG for oocyte maturation prior to follicle aspiration. GnRH-agonist triggers are proven to lower ovarian hyperstimulation syndrome risk, a condition that can be life threatening. Lower pregnancy rates have been reported in the literature with the GnRH-agonist trigger, leading to recommendations of elective embryo cryopreservation, delayed transfer and increased costs to the patient. AIM: To determine if intensive luteal phase support of GnRH-agonist triggered cycles with intramuscular progesterone and oral oestrogen can result in similar pregnancy rates when comparing fresh embryo transfer outcomes with those of hCG triggered cycles. STUDY DESIGN, SIZE, DURATION: The study was a retrospective analysis of 279 fresh embryo transfers in autologous IVF cycles, which took place over the period of one year at Cape Fertility Clinic in Cape Town. RESULTS: Biochemical (49.40% vs 41.84%), clinical (43.37% vs 36.22%) and ongoing pregnancy rates (37.35% vs 33.16%) were higher in the GnRH-agonist triggered arm in comparison to the hCG triggered arm, respectively. Miscarriage rates were similar at 24.29% in the GnRH-agonist arm, versus 20.73% in the hCG triggered arm. None of the results were statistically significant. CONCLUSION: Similar pregnancy rates can be achieved with both hCG and GnRH-agonist triggered IVF cycles by supporting the GnRH-agonist triggered luteal phase with intensive intramuscular progesterone support

    Derailing individualized ovarian stimulation

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    Combined ovulation triggering with GnRH agonist and hCG in IVF patients

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    The aim of the review is to analyse the combination of a gonadotrophin releasing hormone (GnRH) agonist with a human chorionic gonadotrophin (hCG) trigger, for final oocyte maturation in in vitro fertilisation (IVF) cycles. The concept being a ''dual trigger'' combines a single dose of the GnRH agonist with a reduced or standard dosage of hCG at the time of triggering. The use of a GnRH agonist with a reduced dose of hCG in high responders demonstrated luteal phase support with improved pregnancy rates, similar to those after conventional hCG and a low risk of ovarian hyperstimulation syndrome (OHSS). The administration of a GnRH agonist and a standard hCG in normal responders, demonstrated significantly improved live-birth rates and a higher number of embryos of excellent quality, or cryopreserved embryos. The concept of the ''double trigger" represents a combination of a GnRH agonist and a standard hCG, when used 40 and 34 h prior to ovum pick-up, respectively. The use of the ''double trigger" has been successfully offered in the treatment of empty follicle syndrome and in patients with a history of immature oocytes retrieved or with low/poor oocytes yield. Further prospective studies are required to confirm the aforementioned observations prior to clinical implementation

    Gonadotropin-releasing hormone agonist use in men without a cancer registry diagnosis of prostate cancer

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    <p>Abstract</p> <p>Background</p> <p>Use of gonadotropin-releasing hormone (GnRH) agonists has become popular for virtually all stages of prostate cancer. We hypothesized that some men receive these agents after only a limited work-up for their cancer. Such cases may be missed by tumor registries, leading to underestimates of the total extent of GnRH agonist use.</p> <p>Methods</p> <p>We used linked Surveillance, Epidemiology and End-Results (SEER)-Medicare data from 1993 through 2001 to identify GnRH agonist use in men with either a diagnosis of prostate cancer registered in SEER, or with a diagnosis of prostate cancer based only on Medicare claims (from the 5% control sample of Medicare beneficiaries residing in SEER areas without a registered diagnosis of cancer). The proportion of incident GnRH agonist users without a registry diagnosis of prostate cancer was calculated. Factors associated with lack of a registry diagnosis were examined in multivariable analyses.</p> <p>Results</p> <p>Of incident GnRH agonist users, 8.9% had no diagnosis of prostate cancer registered in SEER. In a multivariable logistic regression model, lack of a registry diagnosis of prostate cancer in GnRH agonist users was significantly more likely with increasing comorbidity, whereas it was less likely in men who had undergone either inpatient admission or procedures such as radical prostatectomy, prostate biopsy, or transurethral resection of the prostate.</p> <p>Conclusion</p> <p>Reliance solely on tumor registry data may underestimate the rate of GnRH agonist use in men with prostate cancer.</p
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