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Gonadotrophin-releasing hormone agonist protocols for pituitary suppression in assisted reproduction.

Abstract Gonadotrophin-releasing hormone agonists (GnRHa) are used in assisted reproduction technology (ART) cycles to prevent a luteinizing hormone surge. Various protocols have been described in the literature, such as long protocols (continuous and stop or reduce dose, long luteal, or long follicular protocol); short protocols and ultrashort protocols.
PMID
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Gonadotrophin-releasing hormone agonist protocols for pituitary suppression in assisted reproduction.

Authors

Mayor MeshTerms

Reproductive Techniques, Assisted

Keywords
Journal Title the cochrane database of systematic reviews
Publication Year Start




 
PMID- 21833958
OWN - NLM
STAT- MEDLINE
DA  - 20110811
DCOM- 20111027
LR  - 20151207
IS  - 1469-493X (Electronic)
IS  - 1361-6137 (Linking)
IP  - 8
DP  - 2011
TI  - Gonadotrophin-releasing hormone agonist protocols for pituitary suppression in
      assisted reproduction.
PG  - CD006919
LID - 10.1002/14651858.CD006919.pub3 [doi]
AB  - BACKGROUND: Gonadotrophin-releasing hormone agonists (GnRHa) are used in assisted
      reproduction technology (ART) cycles to prevent a luteinizing hormone surge.
      Various protocols have been described in the literature, such as long protocols
      (continuous and stop or reduce dose, long luteal, or long follicular protocol);
      short protocols and ultrashort protocols. OBJECTIVES: To determine the most
      effective GnRHa protocol as an adjuvant to gonadotrophins in ART cycles. SEARCH
      STRATEGY: We searched the Cochrane Menstrual Disorders and Subfertility Group
      Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL)
      (The Cochrane Library), MEDLINE, EMBASE, CINHAHL and PsycINFO. Reference lists of
      relevant articles were also searched. All the searches were updated to August
      2010. SELECTION CRITERIA: Only randomised controlled trials comparing any two
      protocols of GnRHa in in vitro fertilization (IVF) or intra-cytoplasmic sperm
      injection (ICSI) cycles were included. DATA COLLECTION AND ANALYSIS: The primary 
      outcome measure was live births per women. Secondary outcome measures were
      pregnancy rate, ongoing pregnancy rate, number of oocytes retrieved and amount of
      gonadotrophins used. Data were independently extracted in 2 x 2 tables by two
      authors. Odds ratios (OR) with 95% confidence intervals (CI) were calculated
      after verifying the presence of homogeneity of treatment effect across all
      trials. For continuous variables mean differences (MD) were calculated. MAIN
      RESULTS: Of 29 included studies, 17 compared long with short protocols; two
      compared long with ultrashort protocols; four compared a follicular versus luteal
      start of GnRHa; three compared continuation versus stopping the GnRHa at the
      start of stimulation; three compared continuation of the same dose versus reduced
      dose of GnRHa and one compared a short versus short stop protocol.There was no
      evidence of a difference in the live birth rate but this outcome was only
      reported by three studies.There was evidence of a significant increase in
      clinical pregnancy rate (OR 1.50, 95% CI 1.16 to 1.93) in a long protocol when
      compared to a short protocol. That is there is a 50% increase in chance of
      achieving pregnancy if a long protocol is used as compared to a short protocol,
      although this difference could range from 16% to 93% increased chance of
      pregnancy. This difference did not persist when the meta-analysis was done only
      on the studies with adequate randomisation (OR 1.38, 95% CI 0.93 to 2.05).There
      was evidence of an increased number of oocytes (MD 1.61, 95% CI 0.18 to 3.04)
      obtained when a long protocol was used as compared to a short protocol. That is
      there is a 60% increase in the number of oocytes retrieved when a long protocol
      is used as compared to a short protocol, although this difference could range
      from 18% to 304% more oocytes.There was evidence of an increase (MD 12.90, 95% CI
      3.29 to 22.51) in the requirement for gonadotrophins in long as compared to short
      protocols. That is approximately 12.9 more ampoules of gonadotrophins were
      consumed when a long protocol was used as compared to a short protocol. This
      difference could range from 3.29 to 22.51 more gonadotrophin ampoules.There was
      no evidence of a difference in any of the outcome measures for luteal versus
      follicular start of GnRHa and stopping versus continuation of GnRHa at the start 
      of stimulation. AUTHORS' CONCLUSIONS: The pregnancy rate was found to be higher
      when GnRHa was used in a long protocol as compared to a short or ultrashort
      protocol. There was no evidence of a difference in live birth rate, but this
      outcome was only reported by three studies. There was no evidence of a difference
      in the outcomes amongst various long protocols; nor that stopping or reducing
      GnRHa at the start of stimulation was associated with a reduced pregnancy rate.
      For all comparison, except a long versus short protocol, there was a lack of
      power.
FAU - Maheshwari, Abha
AU  - Maheshwari A
AD  - Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK, AB25
      2ZL.
FAU - Gibreel, Ahmed
AU  - Gibreel A
FAU - Siristatidis, Charalambos S
AU  - Siristatidis CS
FAU - Bhattacharya, Siladitya
AU  - Bhattacharya S
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
DEP - 20110810
PL  - England
TA  - Cochrane Database Syst Rev
JT  - The Cochrane database of systematic reviews
JID - 100909747
RN  - 0 (Fertility Agents, Female)
RN  - 33515-09-2 (Gonadotropin-Releasing Hormone)
RN  - 57773-63-4 (Triptorelin Pamoate)
RN  - 9002-67-9 (Luteinizing Hormone)
RN  - EFY6W0M8TG (Leuprolide)
RN  - PXW8U3YXDV (Buserelin)
SB  - IM
UIN - Cochrane Database Syst Rev. 2015;11:CD006919. PMID: 26558801
MH  - Buserelin/administration & dosage
MH  - Clinical Protocols
MH  - Drug Administration Schedule
MH  - Female
MH  - Fertility Agents, Female/*administration & dosage
MH  - Gonadotropin-Releasing Hormone/*agonists
MH  - Humans
MH  - Leuprolide/administration & dosage
MH  - Live Birth
MH  - Luteinizing Hormone/*antagonists & inhibitors/metabolism
MH  - Ovulation Induction/*methods
MH  - Pituitary Gland/*drug effects
MH  - Pregnancy
MH  - Pregnancy Rate
MH  - Randomized Controlled Trials as Topic
MH  - *Reproductive Techniques, Assisted
MH  - Triptorelin Pamoate/administration & dosage
EDAT- 2011/08/13 06:00
MHDA- 2011/10/28 06:00
CRDT- 2011/08/12 06:00
AID - 10.1002/14651858.CD006919.pub3 [doi]
PST - epublish
SO  - Cochrane Database Syst Rev. 2011 Aug 10;(8):CD006919. doi:
      10.1002/14651858.CD006919.pub3.

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