Effect of GnRH Agonist Treatment Protocols on Ovarian Reserve
Condition: Intracytoplasmic Sperm Injection; GnRH Agonist; Infertility; Ovarian Reserve
MeSH terms: Infertility
Study type: Interventional

Summary: 
      This study aimed to compare the gonadotropin-releasing hormone agonist (ultra-short) protocol
      versus (short and long) protocols on ovarian reserve in women undergoing intracytoplasmic
      sperm injection
    

Detailed description: 
      Infertility affects about 15% of all the couples attempting to generate pregnancy, of which
      can be attributed to female and male factors. For females, advanced age and poor ovarian
      reserve were the main causes which resulted in infertility.

      Pituitary down-regulation with gonadotropin-releasing hormone (GnRH) agonists followed by
      ovarian stimulation with exogenous gonadotropins has been successfully used as standard
      hormonal treatment in women undergoing assisted reproductive technologies (ART) for the last
      10 years. Ovulation induction is a frequently utilized therapeutic procedure for the
      management of infertility.

      With the use of gonadotropin-releasing hormone agonists in controlled ovarian
      hyperstimulation (COH) protocols, the results of the ART improved in terms of reduction in
      cycle cancellation by the almost abolition of spontaneous LH surges (<2%). The GnRHa also
      reduce inadequate follicular development and imprecise clinical pregnancy rate.

      Intracytoplasmic sperm injection (ICSI), it has allowed successful pregnancies and proved to
      be a consistent treatment for the alleviation of infertility due to severe semen
      abnormalities including cryptozoospermia.
    

Intervention name(s): ultrashort GnRHa; short GnRHa; long GnRHa
Intervention type(s): Drug; Drug; Drug
Intervention description(s): the patients used the ultrashort protocols with GnRH agonist (GnRH-a, and recombinant Follicle-Stimulating Hormone for controlled ovarian hyperstimulation (COH). Form the second day of menstrual cycle, 0.1 mg/d GnRHa will be injected by subcutaneous injection for 3-4 d.
Gonadotropins will be added from the third day of menstrual cycle and the initial gonadotropin doses will be 225-300 IU/d. During the treatment, gonadotropin doses will be adjusted according to guided monitoring of follicle growth and measurement of serum estradiol (E2) levels of 10 000 units of human chorionic gonadotrophin (hCG) will be administered when 43 follicles will be 418 mm; Buserelin acetate 100 mg five times daily and FSH will be started on the 2nd day of the menstrual cycle as short application. The dose of gonadotropin hormone will be individualized according to the patient's age and previous stimulation history or response to stimulation. Cycles will be monitored by transvaginal ultrasonography and serum estradiol (E2) levels.
Follicular maturation will be completed by the administration of 10000 IU human chorionic gonadotrophin (hCG) when at least two follicles reached a diameter of >18 mm. Thirty-five to thirty-six hours after human chorionic gonadotrophin (hCG) administration, ovum retrieval will be performed by transvaginal echo-guided ovarian puncture.; In the long protocol, daily subcutaneuous injection of Triptorelin :Decapeptyl 0.1 mg (Ferring, Switzerland) 0.1 mg started at day 21 of the cycle prior to stimulation cycle and continued till the day of hCG triggering. Gn stimulation started after fulfilling stimulation start criteria of thin endometrium < 5 mm and low estradiol (E2) < 50 and Luteinizing Hormone < 5IU/l with either HMG(Menogon; Ferring, Switzerland) or rFSH (Gonal-f; Merck Serono, Germany) in a starting dose of 150-300 IU/day according to women age, day 3 Follicle-Stimulating Hormone, Anti-Müllerian Hormone and previous gonadotropin response then adjustment of the dose according to ovarian response monitored by serum estradiol (E2) and ultrasound evaluation.
Other intervention name(s): ultrashort gonadotropin-releasing hormone (GnRH) agonist; short gonadotropin-releasing hormone (GnRH) agonist; long gonadotropin-releasing hormone (GnRH) agonist
Intervention MeSH terms: Hormones
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment