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42B - Pituitary Suppression Using GnRH Agonist for IVF Is Outdated

Against

from Section VIII - Ovarian Stimulation

Published online by Cambridge University Press:  25 November 2021

By
Cornelis B Lambalk
Edited by
Roy Homburg ,
Adam H. Balen  and
Robert F. Casper
Roy Homburg
Affiliation:
Homerton University Hospital, London
Adam H. Balen
Affiliation:
Leeds Centre for Reproductive Medicine
Robert F. Casper
Affiliation:
Mount Sinai Hospital, Toronto
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Summary

What is the principle? The aim of the treatment with either the agonist or the antagonist is to prevent premature luteinisation. And the idea that immediate blockade with a GnRH antagonist should be simple, safe and versatile compared to the complex road the agonist has to take via desensitisation is highly valid and understandable. So do both drugs do what they promise and to the same extent? The answer is no, as elegantly demonstrated in an analysis by Kolibianakis, which shows that daily agonist yielded less than 1% of cycles premature LH secretion against 8% with antagonist (1). Remarkably many LH rises occurred before the antagonist treatment was even started.

Type
Chapter
Information
50 Big Debates in Reproductive Medicine , pp. 219 - 221
Publisher: Cambridge University Press
Print publication year: 2021

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References

Kolibianakis, EM, Venetis, CA, Kalogeropoulou, L, Papanikolaou, E, Tarlatzis, BC. Fixed versus flexible gonadotropin-releasing hormone antagonist administration in in vitro fertilization: a randomized controlled trial. Fertil Steril. 2011;95:558–62.CrossRefGoogle ScholarPubMed
Lambalk, CB, Banga, FR, Huirne, JA, et al. GnRH antagonist versus long agonist protocols in IVF: a systematic review and meta-analysis accounting for patient type. Hum Reprod Update. 2017 Sept 1;23(5):560–79.CrossRefGoogle ScholarPubMed
Braakhekke, M, Kamphuis, EI, Dancet, EA, Mol, F, van der Veen, F, Mol, BW. Ongoing pregnancy qualifies best as the primary outcome measure of choice in trials in reproductive medicine: an opinion paper. Fertil Steril. 2014 May;101(5):1203–4.CrossRefGoogle Scholar
Toftager, M, Bogstad, J, Bryndorf, T, et al. Risk of severe ovarian hyperstimulation syndrome in GnRH antagonist versus GnRH agonist protocol: RCT including 1050 first IVF/ICSI cycles. Hum Reprod. 2016;31:1253–64.CrossRefGoogle ScholarPubMed
Bosch, E, Broer, S, Griesinger, G, et al. ESHRE guideline: ovarian stimulation for IVF/ICSI. Hum Reprod Open. 2020 May 1;2020(2).Google ScholarPubMed
van den Wijngaard, L, van Wely, M, Dancet, EA, et al. Patients’ preferences for gonadotrophin-releasing hormone analogs in in vitro fertilization. Gynecol Obstet Invest. 2014;78:16–21.CrossRefGoogle ScholarPubMed

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