Clinical and endocrine response to the withdrawal of gonadotropin-releasing hormone agonists during prolonged coasting  

Oleh:

Basil, Ho Yuen ; Nguyen, Tuan-Anh T. ; Cheung, Anthony P. ; Leung, Peter C. K.

Jenis: Article from Journal - ilmiah internasional
Dalam koleksi: Fertility and Sterility (keterangan: ada di ClinicalKey) vol. 92 no. 02 (Aug. 2009), page 499-507.
Topik: Withdrawing GnRH agonists; ovarian hyperstimulation syndrome; coasting; IVF; ICSI

Ketersediaan

Perpustakaan FK Nomor Panggil: F02.K.2009.03 Non-tandon: 1 (dapat dipinjam: 0) Tandon: tidak ada

Lihat Detail Induk

Isi artikel

Objective To compare the clinical and endocrine response of cycles in which GnRH agonists (GnRH-a) were stopped with cycles in which the agonists were continued during coasting. Design Retrospective study of stimulation cycles using flare and luteal agonist protocols. Setting Academic. Patient(s) Fifty-nine IVF and intracytoplasmic sperm injection (ICSI) treatment cycles in 57 women, coasted for 3 or more days. Intervention(s) The GnRH-a were withdrawn when E2 levels continued to increase during coasting. Main Outcome Measure(s) Hormone concentrations, ultrasound findings, cycle cancellation, ovarian hyperstimulation syndrome (OHSS), oocyte retrieval, fertilization, embryo transfer, and clinical pregnancy rates (PR). Result(s) In the GnRH-a withdrawn group E2 levels decreased by 63% (18,043–6,656 pmol/L) without cycle cancellations or cases of severe OHSS. In the agonist continuation group, the spontaneous E2 decrease was 29% (14,205–10,132 pmol/L) with cycle cancellation and severe OHSS rates of 9.5% (4/42) and 4.8% (2/42), respectively. Oocyte retrieval, fertilization, embryo transfer, and clinical PRs were not compromised by stopping the agonists. Variations in the dynamic responses of FSH, LH, anti-Müllerian hormone, P, and androstenedione (A) levels in these cycles are described. Conclusion(s) Withdrawal of GnRH-a during coasting interrupted increasing E2 levels, prevented cycle cancellation, and mitigated the risk of OHSS in this high risk group without compromising oocyte retrieval, fertilization, embryo transfer, or PRs.

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