Repeated Doses of GnRH Agonist as Oocyte Triggering in Antagonist Protocol for Patients With Polycystic Ovary Syndrome
Condition: Polycystic Ovary Syndrome
MeSH terms: Polycystic Ovary Syndrome; Syndrome
Study type: Interventional

Summary: 
      This is a prospective, randomized, proof-of-concept study, designed to compare the IVF
      results in patients diagnosed with polycystic ovarian syndrome (PCOS) defined as per the
      ESHRE/ASRM Rotterdam criteria (2003) undergoing in-vitro fertilization/ intracytoplasmic
      sperm injection (IVF/ICSI) in antagonist protocol. Patients were randomized into two groups.
      Group A: single dose of GnRHa 0.2 mg, 35 h prior to oocyte retrieval, and Group B: 0.2 mg
      GnRHa 35 h prior to oocyte retrieval + a repeat dose of 0.1 mg 12 h following the 1st dose.
      12 h post-trigger, luteinizing hormone (LH), progesterone (P4) values will be estimated.
    

Detailed description: 
      The aim of this study was to establish if a second dose of GnRHa repeated 12 h following the
      initial dose optimizes the cycle outcome in terms of oocyte maturity in women with PCOS of
      Asian origin.

      The study was approved by the institutional review board and written, informed consent will
      be obtained from each participant. Infertile women with a diagnosis of PCOS, who undergo the
      IVF / ICSI cycle are assigned to two groups randomly. The random method is that the
      statistician will be provided a blocked randomization list for the number of patients,and
      whenever an eligible patient is referred, a sealed envelope will be delivered to the clinical
      physician. The random allocation is concealed from the physician performing the IVF/ICSI
      treatment cycle. All patients will receive antagonist controlled ovarian stimulation protocol
      with same starting dose of gonadotropin. On the day of trigger, serum E2, LH, and P4
      concentrations will be measured. When three lead follicles achieved 17-mm diameter, in group
      A, the final oocyte maturation will be triggered with a single dose of 0.2 mg s.c triptorelin
      (decapeptyl), 35 h prior to oocyte retrieval in both the groups and in Group B, a repeat dose
      of 0.1 mg 12 h following the first dose. Post-trigger, LH, and progesterone levels will be
      measured 12 h following the first dose of GnRHa and ovum-pick up day. Transvaginal
      ultrasound-guided oocyte pickup (OPU) will be performed 35 h following the first dose under
      intravenous sedation with single-lumen oocyte retrieval needle. Post pickup on days 4 and 7,
      an assessment for symptoms and signs of OHSS and patients will be advised to present at any
      time within 2 weeks of GnRHa administration.

      In all subjects, IVF or ICSI will be performed according to the standard operating procedure.
      The fertilization will be assessed 18 h following ICSI or IVF by the appearance of two
      pronuclei. All embryos will be cryopreserved by vitrification in the form of blastocyst. The
      frozen embryo transfer (FET) cycles will be performed following pretreatment with oral
      contraceptive pills in an artificial cycle with a daily dose of orally administered 6 mg of
      estradiol. When the endometrium evaluated by TVS was >8 mm with triple-layer morphology, it
      is considered mature. This will be followed by endometrial priming with 5 days of injectable
      progesterone for blastocysts. The transfer will be performed using Sure-Pro Ultra catheter.
      Luteal-phase supplementation will be continued with vaginal progesterone and estradiol for 14
      days and when pregnancy will be achieved till 10 weeks of gestation..

      The primary outcome will be the maturity rate of the oocytes (the ratio of MII oocytes to the
      total number of oocytes retrieved) and oocyte yield. The secondary outcomes are fertilization
      rate, number and quality of blastocyst embryos, OHSS occurrence, and post-trigger serum LH
      (IU/L), and P4 (ng/mL) levels. In addition, implantation and clinical pregnancy rates will be
      also evaluated. Data collection will be performed by using questionnaires to be filled as per
      the available records and laboratory results. Data analysis will be done through descriptive
      and perceptive statistical methods by using SPSS software version 20 for windows.
    

Intervention name(s): Repeated dose of GnRH agonist
Intervention type(s): Other
Intervention description(s): 0.2 mg triptorelin plus a repeat dose of 0.1 mg 12 hours following the first dose.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Investigator, Outcomes Assessor)
Primary purpose: Treatment