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. 2012 Mar;39(1):33-9.
doi: 10.5653/cerm.2012.39.1.33. Epub 2012 Mar 31.

Preliminary clinical outcome of novel strategy for the maximization of cumulative pregnancy rates per retrieval in normal responders

Jong-Kil Joo  1 , Jong-Ryeol Choi, Jung-Bin Son, Gyoung-Rae Ko, Kyu-Sup Lee
Affiliations

Preliminary clinical outcome of novel strategy for the maximization of cumulative pregnancy rates per retrieval in normal responders

Jong-Kil Joo et al. Clin Exp Reprod Med. 2012 Mar.

Abstract

Objective: We devised a novel strategy, a GnRH antagonist protocol with a GnRH agonist trigger followed by frozen-thawed blastocyst transfers with long zona dissection (LZD). The purpose of this study was to investigate the clinical outcomes of this new strategy according to age.

Methods: Ninety women aged less than 35 (group A) and 32 women aged 35 to 39 (group B) underwent the GnRH antagonist protocol with a GnRH agonist trigger in order to obtain many oocytes and prevent early-onset ovarian hyperstimulation syndrome (OHSS). All oocytes were cultured to the blastocyst stage and all blastocysts grade 3BB or better were cryopreserved. Embryo transfers were only performed in freeze-thaw cycles to prevent late-onset OHSS and to overcome embryo-endometrium dyssynchrony. LZD was performed just after thawing to improve hatching and implantation rates.

Results: The average numbers of retrieved oocytes and blastocysts grade 3BB or better were 12.8±5.5 and 4.4±2.6 in group A and 10.9±7.4 and 2.5±2.2 in group B, respectively, and OHSS did not occur in any of the women. Implantation rates were 46.7% in group A and 39.3% in group B. Cumulative clinical pregnancy rates per retrieval were 77.8% in group A and 62.5% in group B. Cumulative ongoing pregnancy rates per retrieval were 71.1% in group A and 53.1% in group B.

Conclusion: GnRH antagonist protocol with GnRH agonist trigger followed by frozen-thawed blastocyst transfers with LZD can generate many blastocysts without OHSS and maximize cumulative pregnancy rates per retrieval. This strategy is more effective in young women aged less than 35 than in women aged 35 to 39.

Keywords: Blastocyst transfer; Gonadotropin-releasing hormone agonist; Ovarian hyperstimulation syndrome.

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Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Figure 1
Figure 1
Artificial shrinkage using ICSI pipettes. (A) Locate inner cell mass in the 6 or 12 o'clock direction and hold a blastocyst. (B) Insert injection pipette from the 3 o'clock direction. (C) Aspirate blastocoel fluid. (D) Blastocyst after artificial shrinkage.
Figure 2
Figure 2
Long zona dissection using ICSI pipettes just after thawing. (A) Hold a blastocyst in the 9 o'clock direction. (B) Insert the injection pipette from the 3 o'clock direction. (C) Penetrate through the perivitelline space to the 9 o'clock direction. (D) Rub and flick the zona pellucida (ZP) using holding and injection pipettes. (E) Dissected ZP (arrows). (F) Hatching blastocyst. (G) Hatched blastocyst. (D) Remnant ZP after hatching.
See this image and copyright information in PMC

References

    1. Goto S, Kadowaki T, Tanaka S, Hashimoto H, Kokeguchi S, Shiotani M. Prediction of pregnancy rate by blastocyst morphological score and age, based on 1,488 single frozen-thawed blastocyst transfer cycles. Fertil Steril. 2011;95:948–952. - PubMed
    1. Aflatoonian A, Oskouian H, Ahmadi S, Oskouian L. Can fresh embryo transfers be replaced by cryopreserved-thawed embryo transfers in assisted reproductive cycles? A randomized controlled trial. J Assist Reprod Genet. 2010;27:357–363. - PMC - PubMed
    1. Song T, Liu L, Zhou F, Lin XN, Zhang SY. Frozen-thawed embryo transfer (FET) versus fresh embryo transfer in clinical pregnancy rate during in vitro fertilization-embryo transfer. Zhonghua Yi Xue Za Zhi. 2009;89:2928–2930. - PubMed
    1. Kilicdag EB, Haydardedeoglu B, Cok T, Hacivelioglu SO, Bagis T. Premature progesterone elevation impairs implantation and live birth rates in GnRH-agonist IVF/ICSI cycles. Arch Gynecol Obstet. 2010;281:747–752. - PubMed
    1. Kolibianakis E, Bourgain C, Albano C, Osmanagaoglu K, Smitz J, Van Steirteghem A, et al. Effect of ovarian stimulation with recombinant follicle-stimulating hormone, gonadotropin releasing hormone antagonists, and human chorionic gonadotropin on endometrial maturation on the day of oocyte pick-up. Fertil Steril. 2002;78:1025–1029. - PubMed