Journal article Open Access

Early and short follicular GnRH antagonist (Sandwich) protocol versus conventional GnRH antagonist protocol in normal responders and poor responders

Khitam M. Abdul-Hameed; Ula M. AlKawaz; Nadia M. Al- Hilli; Mohammad Oda Selman

Gonadotropin-releasing hormone (GnRH) antagonists are among its analogues that were used to produce prompt down-regulation of pituitary gonadotropin secretion.  During conventional antagonist protocol, exposure to high LH and E2 levels leads to worse clinical reproductive results. The current study aims to investigate how such a modification, a GnRH antagonist in the follicular phase (Sandwich protocol) affects. One hundred six women, 44 normal responders and 82 poor responders undergoing ICSI-ET cycles were randomized into two groups. The conventional GnRH antagonist group 30 normal responders and 31 poor responders to GnRH antagonist was administered as, flexible protocol. In the sandwich protocol group 14 normal responders and 33 poor responders, a GnRH antagonist was administered for three days started from day one of the menstrual cycle and continues as flexible protocol. In the sandwich protocol, mean number of follicles obtained by normal responders was significantly higher than that obtained by poor responders, the mean numbers of retrieved oocytes as well as that of MII oocytes were significantly higher in normal responders than in poor responders. Estradiol at trigger was significantly higher in normal responders than in poor responders. Mean total number of embryos and the mean number of frozen embryos were significantly higher inthe normal than in the poor responders. The rate of pregnancy was significantly higher in the normal than in the poor responders. Within conventional GnRH antagonist protocol, the mean numbers of retrieved oocytes as well as that of MII oocytes were significantly higher in the normal responders. Mean total number of embryos, mean grade 1 embryo percentage andthe mean number of frozen embryos were significantly higher in the normal than in the poor responders, the mean grade 1 embryo percentage was also significantly higher in normal than in poor responders, and the rate of pregnancy was significantly higher in the normal than in the poor responders. Early and short GnRH antagonists proved improvements in the synchronization of follicular development, in the number of mature oocytes retrieved, in the number of total embryos, in the number of frozen embryos, as well as the pregnancy rates.

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