Cover
Vol. 9 No. 1 (2019)

Published: November 30, 2019

Pages: 68-88

Research Article

Early and Short Follicular GnRH Antagonist (Sandwich) Protocol Versus Conventional GnRH Antagonist Protocol in Normal Responders

Khitam M. Abdul-Hameed 1 Ula M.R. Al-Kawaz Nadia M. Al-Hilli 2
1High Institute of Infertility Diagnosis and Assisted Reproductive Technologies, Al Nahrain University, Baghdad, Iraq
2Department of Obstetrics and Gynecology, College of Medicine, University of Babylon, Babylon, Iraq
History
  • Received: May 16, 2019
  • Accepted: November 16, 2019
  • Available Online: November 17, 2019
DOI

https://doi.org/10.28969/IJEIR.v9.i1.r5

Abstract

Gonadotropin-releasing hormone antagonists are one of the GnRH analogs that were used in assisted reproductive technologies to produce prompt downregulation of pituitary gonadotropin secretion. During conventional antagonist protocol (CAP), exposure to high LH and E 2 occur that have the potential to worse clinical reproductive results. So the downregulation of pituitary secretion for short period during early follicular phase will result in synchrony in follicular developments and this will improve mature oocytes and total embryos numbers. 44 women as normal responders undergoing ICSI-ET cycles were randomized into two groups. The conventional group (CG) (n 30), gonadotropin started from menstrual cycle day 2 or 3 and continue until hCG trigger day, flexible protocol in which GnRH antagonists administered with follicular size (13-14 mm). In the sandwich group (SG) (n 14), a GnRH antagonist was administered for three days in which GnRH antagonists administered with follicular size (13-14 mm). Gonadotropin started from menstrual cycle day 3 and continue until hCG trigger day. Retrieved and MII oocyte mean numbers were significantly higher in SG than in CG ( P = 0.006, and 0.025), respectively. Embryos and frozen embryos mean total numbers were significantly higher in SG than in CG ( P = 0.004). SG patients have a higher pregnancy rate of 9/14 (64.3 %) than CG 12/30 (40.0 %) although not significant ( P =0.057). Early and short GnRH antagonists proved improvements in synchronization of follicular development, retrieved mature oocytes numbers, total embryos, frozen embryos, and pregnancy rates.

Keywords

References

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  25. Kolibianakis E, Albano C, Camus M, Tournaye H, Van Steirteghem A, Devoroey P. Initiation of gonadotropin releasing hormone antagonist on day 1 as compared to day 6 of stimulation: effect on hormonal levels and follicular development in in vitro fertilization cycles. Journal of Clinical and Endocrinological Metabolism. 2003,88:5632-5637. Doi: https://doi.org/10.1210/jc.2003- 030805 [PubMed][OxFord] Biography Dr. Khitam Malik Abdul-Hameed She was born in Karbala in 1976. She received M.B.CH.B. from Al- Mustansiriya University, College of Medicine in 2001, the High Diploma in ART from Al-Nahrain University, the High Institute for Infertility Diagnosis and ART's in 2010, the Ph.D. in Infertility and Clinical Reproduction from Al Nahrain University, the High Institute for Infertility Diagnosis and ART's in 2019. Dr. Ula M. R. Al-Kawaz He is a Professor of Urology at Al-Nahrain University. Currently he is the dean of the high institute of infertility diagnosis and ARTs, Al Nahrain University. He is a fellow of the Iraqi Board for Medical Specialization, Council of Urology since 2006, and a fellow of the European Board of Urology, since 2009. He published more than 27 articles both local and international. He supervised many M.Sc. and Ph.D. students. Dr. Nadia Mudher Sulaiman Al-Hilli She was born in Babylon, Iraq in 1976. She received the M.B.Ch.B. from College of Medicine, University of Babylon in 1999, the Diploma in Obstetrics & Gynecology in 2005, Iraqi Board in Obstetrics & Gynecology (FIBMS) in 2006, the Part I MRCOG in 2006, and the Certificate of minimal access surgery from the Iraqi Ministry of Health in 2017. Currently she is an Assistant Professor, and the Head of department in Obstetrics & Gynecology department, College of Medicine, University of Babylon. She is also a lecturer and supervisor of PhD students in the High Institute of Infertility and Assisted Reproductive Technologies since 2016. She is a member in the medical education committee in University of Babylon, College of Medicine, and a member of scientific committee of Obs. & Gyne. department in the University of Babylon, College of Medicine. She participated in more than, 25 Symposiums, 3 International Symposiums, 18 National Conferences, 15 International Conferences, 16 Workshops, and 9 Training Courses. She published more than 21 articles both local and international. She has more than 200 diagnostic & operative hysteroscopy operations & More than 200 diagnostic and operative laparoscopies performed for infertility patients. How to cite: Abdul-Hameed KM, Al-Kawaz UMR, Al-Hilli NM. Early and Short Follicular GnRH Antagonist (Sandwich) Protocol Versus Conventional GnRH Antagonist Protocol in Normal Responders; Iraqi Journal of Embryos and Infertility Researches (IJEIR), (2019);9(1):68-88. Doi: http://doi.org/10.28969/IJEIR.v9.i1.r5 © 2019 Author(s)