Research Article
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Comparison of the luteal phase estradiol priming stimulation and standard antagonist protocols in patients with diminished ovarian reserve undergoing ICSI

Year 2022, Volume: 6 Issue: 5, 577 - 581, 01.05.2022
https://doi.org/10.28982/josam.1026448

Abstract

Background/Aim: No consensus on the optimal stimulation protocol for increasing in vitro fertilization (IVF) treatment's success rate in patients with diminished ovarian reserve is available. This study aimed to compare IVF outcomes in patients with diminished ovarian reserve (DOR) stimulated with a luteal phase estradiol (E2) priming protocol versus the standard antagonist protocol.
Methods: This retrospective cohort study included 603 patients who underwent intracytoplasmic sperm injection cycles (ICSI) after the diagnosis of DOR and who were stimulated with the luteal E2 priming protocol (E2 priming group; n = 181) or the standard antagonist protocol (antagonist group; n = 422). Groups were compared in terms of demographic characteristics, ovarian stimulation results, ICSI cycle outcomes, clinical pregnancy, and live birth rates per embryo transfer.
Results: The duration of ovarian stimulation was longer, and the total gonadotropin dose used was significantly higher (P = 0.001) in the E2 priming group than in the antagonist group. The number of embryos transferred was higher in the antagonist group when compared with E2 priming group (0.87 (0.75) versus 0.64 (0.49); P = 0.01), but no statistically significant difference in terms of embryo quality between groups was found (P > 0.05). The cycle cancellation rate, clinical pregnancy, and live birth rates per embryo transfer were similar in both groups.
Conclusions: No difference between IVF outcomes in the patients diagnosed with DOR who were stimulated with the antagonist protocol and the luteal E2 priming protocol was detected. The antagonist protocol might be considered more advantageous because of the shorter treatment duration and lower doses of gonadotropin. This protocol also allows more embryos to be transferred. Additional randomized controlled trials are needed to verify these findings.

References

  • 1. Levi AJ, Raynault MF, Bergh PA, Drews MR, Miller BT, Scott RT Jr. Reproductive outcome in patients with diminished ovarian reserve. Fertil Steril. 2001;76:666–9. doi: 10.1016/S0015-0282(01)02017-9
  • 2. Keay SD, Liversedge NH, Mathur RS, Jenkins JM. Assisted conception following poor ovarian response to gonadotrophin stimulation. Br J Obstet Gynaecol. 1997;104:521–7. doi: 10.1111/j.1471-0528.1997.tb11525.x
  • 3. Sunkara SK, Rittenberg V, Raine-Fenning N, Bhattacharya S, Zamora J, Coomarasamy A. Association between the number of eggs and live birth in IVF treatment: an analysis of 400 135 treatment cycles. Hum Rep. 2011;26:1768–74. doi: 10.1093/humrep/der106
  • 4. Weissman A, Howles CM, Sunkara SK. Treatment strategies in assisted reproduction for the low responder patient. In:Gardner DK, eds. Textbook of Assisted Reproductive Technologies. 3rd ed. London: Informa Health Care; 2009. p.p. 585‑586.
  • 5. Land JA, Yarmolinskaya MI, Dumoulin JC, Evers JL. High‑dose human menopausal gonadotropin stimulation in poor responders does not improve in vitro fertilization outcome. Fertil Steril. 1996;65:961‑65. doi: 10.1016/S0015-0282(16)58269-7
  • 6. Chang EM, Han JE, Won HJ, Kim YS, Yoon TK, Lee WS. Effect of estrogen priming through luteal phase and stimulation phase in poor responders in in‑vitro fertilization. J Assist Reprod Genet. 2012;29:225‑30. doi: 10.1007/s10815-011-9685-7
  • 7. Kolibianakis EM, Venetis CA, Diedrich K, Tarlatzis BC, Griesinger G. Addition of growth hormone to gonadotrophins in ovarian stimulation of poor responders treated by in‑vitro fertilization: A systematic review and meta‑analysis. Hum Reprod Update. 2009;15:613‑22. doi: 10.1093/humupd/dmp026
  • 8. Battaglia C, Salvatori M, Maxia N, Petraglia F, Facchinetti F, Volpe A. Adjuvant L‑arginine treatment for in‑vitro fertilization in poor responder patients. Hum Reprod. 1999;14:1690‑7. doi: 10.1093/humrep/14.7.1690
  • 9. Zangmo R, Singh N, Sharma JB. Diminished ovarian reserve and premature ovarian failure: A review. [Downloaded free from http://www.ivflite.org on Monday, March 8, 2021, IP: 5.176.146.113]
  • 10. Baczkowski T, Kurzawa R, Glabowski W. Methods of embryo scoring in in vitro fertilization. Reprod Biol 2004; 4: 5–22
  • 11. Bukulmez O. Definitions and Relevance: Diminished Ovarian Reserve, Poor Ovarian Response, Advanced Reproductive Age, and Premature Ovarian Insufficiency. In: Bukulmez O. (eds) Diminished Ovarian Reserve and Assisted Reproductive Technologies. Cham Springer, 2020. p.p. 55-61
  • 12. Cohen J, Chabbert-Buffet N, Darai E. Diminished ovarian reserve, premature ovarian failure, poor ovarian responder--a plea for universal definitions. J Assist Reprod Genet. 2015;32:1709-12. doi: 10.1007/s10815-015-0595-y
  • 13. Check JH, Amui J, Choe JK, Cohen R. The effect of a rise or fall of serum estradiol the day before oocyte retrieval in women aged 40– 42 with diminished egg reserve. Clin Exp Obstet Gynecol. 2015;42:282–4.
  • 14. Huang LN, Jun SH, Drubach N, Dahan MH. Predictors of in vitro fertilization outcomes in women with highest follicle-stimulating hormone levels ≥12 IU/L: A prospective cohort study. PLoS One. 2015;10:e0124789. doi: 10.1371/journal.pone.0124789
  • 15. Dragisic KG, Davis OK, Fasouliotis SJ, Rosenwaks Z. Use of a luteal estradiol patch and a gonadotropin-releasing hormone antagonist suppression protocol before gonadotropin stimulation for in vitro fertilization in poor responders. Fertil Steril. 2005;84:1023-26. doi: 10.1016/j.fertnstert.2005.04.031
  • 16. Fanchon R, Salomon L, Castelo-Branco A, Olivennes F, Frydman N, Frydman R. Luteal estradiol pre-treatment coordinates follicular growth during controlled ovarian hyperstimulation with GnRH antagonists. Hum Reprod. 2003;18:2698–703. doi: 10.1093/humrep/deg516
  • 17. de Ziegler D, Jääskeläinen AS, Brioschi PA, Fanchin R, Bulletti C. Synchronization of endogenous and exogenous FSH stimuli in controlled ovarian hyperstimulation (COH). Hum Reprod. 1998;13:561–4. doi: 10.1093/humrep/13.3.561
  • 18. Frattarelli JL, Hill MJ, McWilliams GD. A luteal estradiol protocol for expected poor-responders improves embryo number and quality. Fertil Steril. 2008;89:1118–22. doi: 10.1016/j.fertnstert.2007.05.025
  • 19. Hill MJ, McWilliams GDE, Miller KA, Scott RT, Frattarelli JL. A luteal estradiol protocol for anticipated poor-responder patients may improve delivery rates. Fertil Steril. 2009;91:739-43. doi: 10.1016/j.fertnstert.2007.12.073
  • 20. Scheffer JB, Scheffer BB, Carvalho RF, Aguiar AP, Lozano DHM, Labrosse J, et al. A comparison of the effects of three luteal phase support protocols with estrogen on in vitro fertilization-embryo transfer outcomes in patients on a GnRH antagonist protocol. JBRA Assist Reprod 2019;23:239-45. doi: 10.5935/1518-0557.20190012
  • 21. Mutlu MF, Mutlu I, Erdem M, Guler I, Erdem A. Comparison of the standard GnRH antagonist protocol and the luteal phase estradiol/GnRH antagonist priming protocol in poor ovarian responders. Turk J Med Sci. 2017;47:470-75. doi:10.3906/sag-1602-111
  • 22. Lee H, Choi HJ, Yang KM, Kim MJ, Cha SH, Yi HJ. Efficacy of luteal estrogen administration and an early follicular Gonadotropin-releasing hormone antagonist priming protocol in poor responders undergoing in vitro fertilization. Obstet Gynecol Sci. 2018;61:102-10. doi: 10.5468/ogs.2018.61.1.102
  • 23. Ghasemzadeh A, Zadeh RD, Farzadi L, Nouri M, Souri A. Effect of Estrogen Priming in Antagonist Cycles in Women With Poor Response to IVF Treatment. Crescent J of Med and Bio Sci. 2020;7:110-15
  • 24. Sefrioui O, Madkour A, Kaarouch I, Louanjli N. Luteal estradiol pretreatment of poor and normal responders during GnRH antagonist protocol. Gynecol Endocrinol. 2019;35:1067-71. doi: 10.1080/09513590.2019.1622086
Year 2022, Volume: 6 Issue: 5, 577 - 581, 01.05.2022
https://doi.org/10.28982/josam.1026448

Abstract

References

  • 1. Levi AJ, Raynault MF, Bergh PA, Drews MR, Miller BT, Scott RT Jr. Reproductive outcome in patients with diminished ovarian reserve. Fertil Steril. 2001;76:666–9. doi: 10.1016/S0015-0282(01)02017-9
  • 2. Keay SD, Liversedge NH, Mathur RS, Jenkins JM. Assisted conception following poor ovarian response to gonadotrophin stimulation. Br J Obstet Gynaecol. 1997;104:521–7. doi: 10.1111/j.1471-0528.1997.tb11525.x
  • 3. Sunkara SK, Rittenberg V, Raine-Fenning N, Bhattacharya S, Zamora J, Coomarasamy A. Association between the number of eggs and live birth in IVF treatment: an analysis of 400 135 treatment cycles. Hum Rep. 2011;26:1768–74. doi: 10.1093/humrep/der106
  • 4. Weissman A, Howles CM, Sunkara SK. Treatment strategies in assisted reproduction for the low responder patient. In:Gardner DK, eds. Textbook of Assisted Reproductive Technologies. 3rd ed. London: Informa Health Care; 2009. p.p. 585‑586.
  • 5. Land JA, Yarmolinskaya MI, Dumoulin JC, Evers JL. High‑dose human menopausal gonadotropin stimulation in poor responders does not improve in vitro fertilization outcome. Fertil Steril. 1996;65:961‑65. doi: 10.1016/S0015-0282(16)58269-7
  • 6. Chang EM, Han JE, Won HJ, Kim YS, Yoon TK, Lee WS. Effect of estrogen priming through luteal phase and stimulation phase in poor responders in in‑vitro fertilization. J Assist Reprod Genet. 2012;29:225‑30. doi: 10.1007/s10815-011-9685-7
  • 7. Kolibianakis EM, Venetis CA, Diedrich K, Tarlatzis BC, Griesinger G. Addition of growth hormone to gonadotrophins in ovarian stimulation of poor responders treated by in‑vitro fertilization: A systematic review and meta‑analysis. Hum Reprod Update. 2009;15:613‑22. doi: 10.1093/humupd/dmp026
  • 8. Battaglia C, Salvatori M, Maxia N, Petraglia F, Facchinetti F, Volpe A. Adjuvant L‑arginine treatment for in‑vitro fertilization in poor responder patients. Hum Reprod. 1999;14:1690‑7. doi: 10.1093/humrep/14.7.1690
  • 9. Zangmo R, Singh N, Sharma JB. Diminished ovarian reserve and premature ovarian failure: A review. [Downloaded free from http://www.ivflite.org on Monday, March 8, 2021, IP: 5.176.146.113]
  • 10. Baczkowski T, Kurzawa R, Glabowski W. Methods of embryo scoring in in vitro fertilization. Reprod Biol 2004; 4: 5–22
  • 11. Bukulmez O. Definitions and Relevance: Diminished Ovarian Reserve, Poor Ovarian Response, Advanced Reproductive Age, and Premature Ovarian Insufficiency. In: Bukulmez O. (eds) Diminished Ovarian Reserve and Assisted Reproductive Technologies. Cham Springer, 2020. p.p. 55-61
  • 12. Cohen J, Chabbert-Buffet N, Darai E. Diminished ovarian reserve, premature ovarian failure, poor ovarian responder--a plea for universal definitions. J Assist Reprod Genet. 2015;32:1709-12. doi: 10.1007/s10815-015-0595-y
  • 13. Check JH, Amui J, Choe JK, Cohen R. The effect of a rise or fall of serum estradiol the day before oocyte retrieval in women aged 40– 42 with diminished egg reserve. Clin Exp Obstet Gynecol. 2015;42:282–4.
  • 14. Huang LN, Jun SH, Drubach N, Dahan MH. Predictors of in vitro fertilization outcomes in women with highest follicle-stimulating hormone levels ≥12 IU/L: A prospective cohort study. PLoS One. 2015;10:e0124789. doi: 10.1371/journal.pone.0124789
  • 15. Dragisic KG, Davis OK, Fasouliotis SJ, Rosenwaks Z. Use of a luteal estradiol patch and a gonadotropin-releasing hormone antagonist suppression protocol before gonadotropin stimulation for in vitro fertilization in poor responders. Fertil Steril. 2005;84:1023-26. doi: 10.1016/j.fertnstert.2005.04.031
  • 16. Fanchon R, Salomon L, Castelo-Branco A, Olivennes F, Frydman N, Frydman R. Luteal estradiol pre-treatment coordinates follicular growth during controlled ovarian hyperstimulation with GnRH antagonists. Hum Reprod. 2003;18:2698–703. doi: 10.1093/humrep/deg516
  • 17. de Ziegler D, Jääskeläinen AS, Brioschi PA, Fanchin R, Bulletti C. Synchronization of endogenous and exogenous FSH stimuli in controlled ovarian hyperstimulation (COH). Hum Reprod. 1998;13:561–4. doi: 10.1093/humrep/13.3.561
  • 18. Frattarelli JL, Hill MJ, McWilliams GD. A luteal estradiol protocol for expected poor-responders improves embryo number and quality. Fertil Steril. 2008;89:1118–22. doi: 10.1016/j.fertnstert.2007.05.025
  • 19. Hill MJ, McWilliams GDE, Miller KA, Scott RT, Frattarelli JL. A luteal estradiol protocol for anticipated poor-responder patients may improve delivery rates. Fertil Steril. 2009;91:739-43. doi: 10.1016/j.fertnstert.2007.12.073
  • 20. Scheffer JB, Scheffer BB, Carvalho RF, Aguiar AP, Lozano DHM, Labrosse J, et al. A comparison of the effects of three luteal phase support protocols with estrogen on in vitro fertilization-embryo transfer outcomes in patients on a GnRH antagonist protocol. JBRA Assist Reprod 2019;23:239-45. doi: 10.5935/1518-0557.20190012
  • 21. Mutlu MF, Mutlu I, Erdem M, Guler I, Erdem A. Comparison of the standard GnRH antagonist protocol and the luteal phase estradiol/GnRH antagonist priming protocol in poor ovarian responders. Turk J Med Sci. 2017;47:470-75. doi:10.3906/sag-1602-111
  • 22. Lee H, Choi HJ, Yang KM, Kim MJ, Cha SH, Yi HJ. Efficacy of luteal estrogen administration and an early follicular Gonadotropin-releasing hormone antagonist priming protocol in poor responders undergoing in vitro fertilization. Obstet Gynecol Sci. 2018;61:102-10. doi: 10.5468/ogs.2018.61.1.102
  • 23. Ghasemzadeh A, Zadeh RD, Farzadi L, Nouri M, Souri A. Effect of Estrogen Priming in Antagonist Cycles in Women With Poor Response to IVF Treatment. Crescent J of Med and Bio Sci. 2020;7:110-15
  • 24. Sefrioui O, Madkour A, Kaarouch I, Louanjli N. Luteal estradiol pretreatment of poor and normal responders during GnRH antagonist protocol. Gynecol Endocrinol. 2019;35:1067-71. doi: 10.1080/09513590.2019.1622086
There are 24 citations in total.

Details

Primary Language English
Subjects Obstetrics and Gynaecology
Journal Section Research article
Authors

Sezin Ertürk Aksakal 0000-0002-4418-7319

Oya Aldemir 0000-0002-6236-2774

İnci Kahyaoğlu 0000-0002-2283-9128

İskender Kaplanoğlu This is me 0000-0001-8065-5143

Serdar Dilbaz This is me 0000-0001-9542-2799

Publication Date May 1, 2022
Published in Issue Year 2022 Volume: 6 Issue: 5

Cite

APA Ertürk Aksakal, S., Aldemir, O., Kahyaoğlu, İ., Kaplanoğlu, İ., et al. (2022). Comparison of the luteal phase estradiol priming stimulation and standard antagonist protocols in patients with diminished ovarian reserve undergoing ICSI. Journal of Surgery and Medicine, 6(5), 577-581. https://doi.org/10.28982/josam.1026448
AMA Ertürk Aksakal S, Aldemir O, Kahyaoğlu İ, Kaplanoğlu İ, Dilbaz S. Comparison of the luteal phase estradiol priming stimulation and standard antagonist protocols in patients with diminished ovarian reserve undergoing ICSI. J Surg Med. May 2022;6(5):577-581. doi:10.28982/josam.1026448
Chicago Ertürk Aksakal, Sezin, Oya Aldemir, İnci Kahyaoğlu, İskender Kaplanoğlu, and Serdar Dilbaz. “Comparison of the Luteal Phase Estradiol Priming Stimulation and Standard Antagonist Protocols in Patients With Diminished Ovarian Reserve Undergoing ICSI”. Journal of Surgery and Medicine 6, no. 5 (May 2022): 577-81. https://doi.org/10.28982/josam.1026448.
EndNote Ertürk Aksakal S, Aldemir O, Kahyaoğlu İ, Kaplanoğlu İ, Dilbaz S (May 1, 2022) Comparison of the luteal phase estradiol priming stimulation and standard antagonist protocols in patients with diminished ovarian reserve undergoing ICSI. Journal of Surgery and Medicine 6 5 577–581.
IEEE S. Ertürk Aksakal, O. Aldemir, İ. Kahyaoğlu, İ. Kaplanoğlu, and S. Dilbaz, “Comparison of the luteal phase estradiol priming stimulation and standard antagonist protocols in patients with diminished ovarian reserve undergoing ICSI”, J Surg Med, vol. 6, no. 5, pp. 577–581, 2022, doi: 10.28982/josam.1026448.
ISNAD Ertürk Aksakal, Sezin et al. “Comparison of the Luteal Phase Estradiol Priming Stimulation and Standard Antagonist Protocols in Patients With Diminished Ovarian Reserve Undergoing ICSI”. Journal of Surgery and Medicine 6/5 (May 2022), 577-581. https://doi.org/10.28982/josam.1026448.
JAMA Ertürk Aksakal S, Aldemir O, Kahyaoğlu İ, Kaplanoğlu İ, Dilbaz S. Comparison of the luteal phase estradiol priming stimulation and standard antagonist protocols in patients with diminished ovarian reserve undergoing ICSI. J Surg Med. 2022;6:577–581.
MLA Ertürk Aksakal, Sezin et al. “Comparison of the Luteal Phase Estradiol Priming Stimulation and Standard Antagonist Protocols in Patients With Diminished Ovarian Reserve Undergoing ICSI”. Journal of Surgery and Medicine, vol. 6, no. 5, 2022, pp. 577-81, doi:10.28982/josam.1026448.
Vancouver Ertürk Aksakal S, Aldemir O, Kahyaoğlu İ, Kaplanoğlu İ, Dilbaz S. Comparison of the luteal phase estradiol priming stimulation and standard antagonist protocols in patients with diminished ovarian reserve undergoing ICSI. J Surg Med. 2022;6(5):577-81.