Novel treatment modalities
Seema Chopra in Endometriosis, 2020
GnRH antagonists act by causing direct suppression of gonadotropin release from the pituitary in a dose-dependent manner; this leads to an immediate decrease in the circulating levels of gonadal steroid hormones [15], thus creating a hypoestrogenic environment to treat ectopic endometriotic implants. As compared to GnRH agonists, GnRH antagonists immediately downregulate gonadotropin secretion by competing with the endogenous GnRH for its pituitary receptors. The advantage is avoidance of initial flare usually encountered with agonist use which may improve the compliance of the patients for long-term use. Another advantage over agonists is that circulating estradiol levels in a woman on an antagonist are in a range that is sufficient to avoid menopausal symptoms because of estrogen deprivation. Available preparations include injectables (ganirelix, cetrorelix) and oral nonpeptide forms (elagolix, abarelix, ozarelix, TAK-385) [16]. Cetrorelix (3 mg subcutaneously every week for 2 months) was used in 15 patients after laparoscopic surgery of endometriosis [17]. All patients were symptom-free during the treatment; the serum level of E2 oscillated around a mean concentration of 50 pg/mL, and there was almost complete lack of adverse events related to hypoestrogenism. A minority experienced headache (20%) and irregular bleeding (20%).
Treatment strategies in assisted reproduction for the poor-responder patient
David K. Gardner, Ariel Weissman, Colin M. Howles, Zeev Shoham in Textbook of Assisted Reproductive Techniques, 2017
Akman et al. (144) compared a GnRH-ant protocol to a protocol using gonadotropins alone in poor responders. In total, 20 women were randomized to each group. Women assigned to the antagonist arm received 0.25 mg of cetrorelix according to the flexible protocol, and all women were initially stimulated with 600 IU of urinaryderived gonadotropin. There was no statistically significant difference between the groups for cancelation rates, gonadotropin requirements, number of mature oocytes retrieved, E2 concentrations on the day of hCG administration, fertilization rates, and number of embryos transferred. The clinical pregnancy and implantation rates in the antagonist group appeared higher, but were not significantly different (20.00% and 13.33% compared with 6.25% and 3.44%, respectively) because of the small numbers involved.
Main Classes of Drugs
Jerome Z. Litt, Neil H. Shear in Litt's Drug Eruption & Reaction Manual, 2017
Gonadotropin-releasing hormone (GnRH)agonistBuserelinGoserelinHistrelinLeuprolideNafarelinTriptorelinantagonistAbarelixCetrorelixDegarelixGanirelix
A retrospective analysis of artificial oocyte activation in patients with low or no fertilisation in intracytoplasmic sperm injection cycles
Published in Journal of Obstetrics and Gynaecology, 2022
Kevin K. W. Lam, Jacki Y. Y. Wong, Tak-Ming Cheung, Raymond H. W. Li, Ernest H. Y. Ng, William S. B. Yeung
For ovarian stimulation, either gonadotrophin releasing hormone (GnRH) antagonist or long agonist protocol were used. In the antagonist protocol, subcutaneous injection of cetrorelix 0.25 mg (Cetrotide®; Merck Serono, Geneva, Switzerland) was started from the sixth day of gonadotrophin injection. In the agonist protocol, patients were pre-treated with buserelin (Suprecur®; Sanofi, Paris, France) from mid-luteal phase of the cycle preceding the stimulation cycle for pituitary downregulation. The women received either recombinant follicle-stimulating hormone (Merck Serono) or human menopausal gonadotrophin (Menogon®; Ferring, Saint-Prex, Switzerland) for ovarian stimulation. The dose depended on the antral follicle count prior to ovarian stimulation and was titrated according to the ovarian response during stimulation. Oocyte maturation was triggered by either human chorionic gonadotrophin or gonadotrophin-releasing hormone agonist. Transvaginal ultrasound-guided oocyte retrievals were performed after 34−36 h.
Dual trigger with the combination of gonadotropin-releasing hormone agonist and standard dose of human chorionic gonadotropin improves in vitro fertilisation outcomes in poor ovarian responders
Published in Journal of Obstetrics and Gynaecology, 2022
Ilknur Mutlu, Erhan Demirdag, Funda Cevher, Ahmet Erdem, Mehmet Erdem
Antral follicle count (AFC) measurements were carried out on the 3rd day of the cycle. GnRH antagonist protocol was used for all poor-responder patients. The stimulation protocol in both groups included exogenous gonadotropins to a maximum of 375 units in the form of recombinant FSH (Gonal-F, Merck Serono, Turkey) in combination with hMG (Menogon, Ferring, Turkey). Follicular growth monitorization and gonadotropin dose adjustments were performed with serial transvaginal ultrasound and serum E2 measurements to determine the ovarian response to the gonadotropin stimulation. All the sonographic exams were conducted by the Voluson 730 Pro machine (GE Healthcare Austria GmbH & Co OG). 0.25 mg/day subcutaneous cetrorelix (Cetrotide; Asta Medica, Frankfurt, Germany) was started when the leading follicle ≥13 mm or E2 > 300 pg/mL and was continued until the day of ovulation trigger. When at least two follicles were 17 mm or more in mean diameter, final oocyte maturation was triggered by 250 mcg of recombinant hCG (choriogonadotropin alfa) (Ovitrelle, Merck Serono, Turkey) alone in the control (hCG trigger) group or by 250 mcg of recombinant hCG (choriogonadotropin alfa) (Ovitrelle, Merck Serono, Turkey) plus 0.2 mg of triptorelin (Decapepty, Ferring, Turkey) in the study (dual trigger) group. None of the patients were given adjuvant treatments.
Comparison of uterine, endometrial and subendometrial blood flows in predicting pregnancy outcomes between fresh and frozen-thawed embryo transfer after GnRH antagonist protocol: a retrospective cohort study
Published in Journal of Obstetrics and Gynaecology, 2023
Jianmei Yu, Bo Li, Haiyan Li, Qing Li, Zhen Nai, Bo Deng, Yunxiu Li
Patients did not undergo any therapeutic interventions except for routine procedures. A total of 721 women underwent, a standardized GnRH antagonist protocol with recombinant follicle stimulating hormone (FSH) (Gonal-f; Merck Serono, Switzerland) starting on day 2 or 3 of their menses, with doses ranging from 150 to 300 international units per day, according to their age and response to stimulation day 6. A GnRH antagonist (Cetrorelix; Cetrotide, Merck Serono, Switzerland) was used for pituitary suppression when a leading follicle achieved 14 mm. Final oocyte maturation was induced by administration of 250 μg of recombinant human chorionic gonadotropin (hCG) (Ovidrel; Merck Serono, Switzerland) as soon as three follicles reached 18 mm in diameter by ultrasound evaluation. Oocyte retrieval was performed 34–36 h after trigger, and conventional insemination or ICSI was performed as clinically appropriate. The good quality embryos included grade I and grade II embryos.
Related Knowledge Centers
- Chorionic Gonadotropin
- Luteinizing Hormone
- Organic Compound
- Peptide
- In Vitro Fertilisation
- Gonadotropin-Releasing Hormone
- Gonadotropin-Releasing Hormone Antagonist
- Follicle-Stimulating Hormone
- Generic Drug
- Gonadotropin-Releasing Hormone Agonist