Cost-effectiveness of GnRH antagonist implementation on hCG injection day
Yıl: 2019 Cilt: 16 Sayı: 1 Sayfa Aralığı: 29 - 34 Metin Dili: İngilizce DOI: 10.4274/tjod.galenos.2019.56255 İndeks Tarihi: 12-10-2020
Cost-effectiveness of GnRH antagonist implementation on hCG injection day
Öz: Objective: To compare the outcomes of antagonist stimulation protocols and to compare the cost effectiveness.Materials and Methods: Between 2011 and December 2017, a total of 354 women who underwent intracytoplasmic sperm injection and controlled ovarian stimulation with antagonist protocols were enrolled in the study. The antagonist implementation on the day of human chorionic gonadotropin (hCG) was continued for 194 of women, whereas the antagonist was stopped 36 hours before in 160 women. The stimulation outcomes of patients and cost-effectiveness of the regimens were compared.Results: There was a significant difference between the groups in terms of number of cryopreserved embryos, mature/immature oocyte ratio, and embryo transfer cancellations (p<0.05). The median value for the mature/immature oocyte ratio was 1.1 (0.2-7.5) and 1 (0.5-15) (p=0.001), and the ET cancellation was 5.3% vs. 1% for group 1 and 2, respectively (p=0.037). There was no difference between the groups in terms of pregnancy rates (p=0.197).Conclusion: No difference was found in the clinical pregnancy rates between the two groups. For this reason, the cessation of antagonist implementation on the day of hCG seems more advantageous in terms of cost-effectiveness and fewer injections.
Anahtar Kelime: hCG gününde GnRh antagonist yapmanın maliyet etkinliği
Öz: Amaç: Antagonist stimülasyon protokollerinin maliyet etkinliğini ve stimülasyon sonuçlarını kıyaslamaktır.Gereç ve Yöntemler: Çalışmaya 2011-2017 yılları arasında intrastoplazmik sperm enjeksiyonu yapılan 354 hasta alınmıştır. Hastaların tamamında antagonist protokolle stimülasyon yapılmıştır. Hastaların 194 tanesinde insan koryonik gonadotropin (hCG) gününde antagonist yapılmaya devam edilmiştir. Yüz altmış hastada ise antagonist hCG gününden 36 saat önce kesilmiştir. Hastaların stimülasyon sonuçları ve iki farklı rejimin maliyet etkinliği karşılaştırılmıştır.Bulgular: Gruplar arasında dondurulmuş embryo sayısı, matür/immatür oosit oranı ve transfer iptali açısından anlamlı farklılık bulunmuştur (p<0,05). Matür/immatür oosit oranı için medyan değer grup 1 ve grup 2 için 1,1 (0,2-7,5) ve 1 (0,5-15) olarak bulunmuştur (p=0,001). Transfer iptali grup 1 ve grup 2 için %1 ve 5,3 olarak bulunmuştur (p=0,037). Gebelik sonuçları açısından gruplar arasında anlamlı farklılık saptanmamıştır (p=0,197).Sonuç: Klinik gebelik oranları açısından iki grup arasında anlamlı farklılık bulunmamaktadır. Bu nedenle hCG gününde antagonist dozunun atlanması maliyet etkinlik açısından ve daha az enjeksiyon yapılması nedeniyle daha avantajlı olarak görülmektedir.
Anahtar Kelime: Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
- 1. Kolibianakis EM, Tarlatzis B, Devroey P. GnRH antagonists in IVF. Reprod Biomed Online [Internet] 2005;10:705-12. Available from: http://dx.doi.org/10.1016/S1472-6483(10)61113-3.
- 2. Copperman AB, Benadiva C. Optimal usage of the GnRH antagonists: A review of the literature. Reprod Biol Endocrinol 2013;11:1-13.
- 3. Gordon K, Hodgen GD. GnRH agonists and antagonists in assisted reproduction. Baillieres Clin Obstet Gynaecol 1992;6:247-65.
- 4. Olivennes F, Belaisch-Allart J, Emperaire JC, et al. Prospective, randomized, controlled study of in vitro fertilization-embryo transfer with a single dose of a luteinizing hormone-releasing hormone (LHRH) antagonist (cetrorelix) or a depot formula of an LH-RH agonist (triptorelin). Fertil Steril 2000;73:314-20.
- 5. Johnston-MacAnanny EB, DiLuigi AJ, Engmann LL, Maier DB, Benadiva CA, Nulsen JC. Selection of first in vitro fertilization cycle stimulation protocol for good prognosis patients: gonadotropin releasing hormone antagonist versus agonist protocols. J Reprod Med [Internet] 2011;56:12-6. Available from: http://www.ncbi.nlm. nih.gov/pubmed/21366121.
- 6. Al-Inany H, Youssef M. Gonadotrophin-releasing hormone antagonists for assisted reproductive technology. Database Syst Rev [Internet] 2011;CD001750. Available from: http://www.ncbi.nlm. nih.gov/pubmed/21563131%5Cnhttp://onlinelibrary.wiley.com/ doi/10.1002/14651858.CD001750.pub3/pdf/standard
- 7. Chang HJ, Lee JR, Jee BC, Suh CS, Lee WD, Kim SH. Cessation of gonadotropin-releasing hormone antagonist on triggering day in flexible multipledose protocol: A randomized controlled study. Clin Exp Reprod Med 2013;40:83-9.
- 8. Chang HJ, Lee JR, Jee BC, Suh CS, Kim SH. Cessation of gonadotropinreleasing hormone antagonist on triggering day: an alternative method for flexible multiple-dose protocol. Send to J Korean Med Sci 2009;24:262-8.
- 9. Edwards RG, Lobo R, Bouchard P. Time to revolutionize ovarian stimülation. Hum Reprod 1996;11:917-9.
- 10. Tarlatzis BC, Fauser BC, Kolibianakis EM, Diedrich K, Rombauts L, Devroey P. GnRH antagonists in ovarian stimulation for IVF. Hum Reprod Update 2006;12:333-40.
- 11. Griesinger G, Diedrich K, Devroey P, Kolibianakis EM. GnRH agonist for triggering final oocyte maturation in the GnRH antagonist ovarian hyperstimulation protocol: A systematic review and meta-analysis. Vol. 12, Human Reprod Update 2006;12 p. 159-68.
- 12. Prapas Y, Ravanos K, Petousis S, Panagiotidis Y, Papatheodorou A, Margioula-siarkou C, et al. GnRH antagonist administered twice the day before hCG trigger combined with a step-down protocol may prevent OHSS in IVF/ICSI antagonist cycles at risk for OHSS without affecting the reproductive outcomes : a prospective randomized control trial. J Assist Reprod Genet 2017;1537-45.
- 13. Engel JB, Riethmüller-Winzen H DK. Extrapituitary Actions of GnRH Antagonists: Prospects for in vitro Fertilization Programs. Curr Pharm Des 2012;18:264-9.
- 14. Yu B, Ruman J, Christman G. The role of peripheral gonadotropinreleasing hormone receptors in female reproduction. Fertil Steril 2011;95:465-73.
- 15. Cheng CK, Yeung CM, Chow BK, Leung PC. Characterization of a New Upstream GnRH Receptor Promoter in Human Ovarian Granulosa-Luteal Cells. Mol Endocrinol 2002;16:1552-64.
- 16. Humaidan P, Kol S, Papanikolaou EG. GnRH agonist for triggering of final oocyte maturation : time for a change of practice? Hum Reprod Updat 2018;17:510-24.
- 17. Braude P, Bolton V, Moore S. Human gene expression first occurs between the four- and eight-cell stages of preimplantation development. Nature 1988;332:459-61.
- 18. Betts DH, King WA. Genetic regulation of embryo death and senescence. Theriogenology 2001;55:171-91.
- 19. Muñoz M, Cruz M, Humaidan P, Garrido N, Pérez-Cano I, Meseguer M. The type of GnRH analogue used during controlled ovarian stimulation influences early embryo developmental kinetics: a timelapse study. Eur J Obs Gynecol Reprod Biol 2013;168:167-72.
- 20. Venetis CA, Kolibianakis EM, Papanikolaou E, Bontis J, Devroey P, Tarlatzis B. Is progesterone elevation on the day of human chorionic gonadotrophin administration associated with the probability of pregnancy in in vitro fertilization? A systematic review and metaanalysis. Hum Reprod Update 2007;13:343-55.
- 21. Ince O, Ucuran G, Ozvatan Halksever S, Ozer M, Duymus A C , Demir M, et al. Effect of Premature Luteinizing Hormone Rise on Pregnancy Outcomes in Patients with High Trigger Day Progesterone Levels in GnRH Antagonist In Vitro Fertilization Cycles. Turkiye Klin J Gynecol Obs 2017;27:49-56.
- 22. Rackow BW, Kliman HJ, Taylor HS. GnRH antagonists may affect endometrial receptivity. Fertil Steril 2007;89:1234-9.
| APA | ÖZDEMİR A, AYAS B, Güven D, TÜRKMEN A, Gülümser Ç (2019). Cost-effectiveness of GnRH antagonist implementation on hCG injection day. , 29 - 34. 10.4274/tjod.galenos.2019.56255 |
| Chicago | ÖZDEMİR Ayşe Zehra,AYAS Bülent,Güven Davut,TÜRKMEN Aysun,Gülümser Çağrı Cost-effectiveness of GnRH antagonist implementation on hCG injection day. (2019): 29 - 34. 10.4274/tjod.galenos.2019.56255 |
| MLA | ÖZDEMİR Ayşe Zehra,AYAS Bülent,Güven Davut,TÜRKMEN Aysun,Gülümser Çağrı Cost-effectiveness of GnRH antagonist implementation on hCG injection day. , 2019, ss.29 - 34. 10.4274/tjod.galenos.2019.56255 |
| AMA | ÖZDEMİR A,AYAS B,Güven D,TÜRKMEN A,Gülümser Ç Cost-effectiveness of GnRH antagonist implementation on hCG injection day. . 2019; 29 - 34. 10.4274/tjod.galenos.2019.56255 |
| Vancouver | ÖZDEMİR A,AYAS B,Güven D,TÜRKMEN A,Gülümser Ç Cost-effectiveness of GnRH antagonist implementation on hCG injection day. . 2019; 29 - 34. 10.4274/tjod.galenos.2019.56255 |
| IEEE | ÖZDEMİR A,AYAS B,Güven D,TÜRKMEN A,Gülümser Ç "Cost-effectiveness of GnRH antagonist implementation on hCG injection day." , ss.29 - 34, 2019. 10.4274/tjod.galenos.2019.56255 |
| ISNAD | ÖZDEMİR, Ayşe Zehra vd. "Cost-effectiveness of GnRH antagonist implementation on hCG injection day". (2019), 29-34. https://doi.org/10.4274/tjod.galenos.2019.56255 |
| APA | ÖZDEMİR A, AYAS B, Güven D, TÜRKMEN A, Gülümser Ç (2019). Cost-effectiveness of GnRH antagonist implementation on hCG injection day. Turkish Journal of Obstetrics and Gynecology, 16(1), 29 - 34. 10.4274/tjod.galenos.2019.56255 |
| Chicago | ÖZDEMİR Ayşe Zehra,AYAS Bülent,Güven Davut,TÜRKMEN Aysun,Gülümser Çağrı Cost-effectiveness of GnRH antagonist implementation on hCG injection day. Turkish Journal of Obstetrics and Gynecology 16, no.1 (2019): 29 - 34. 10.4274/tjod.galenos.2019.56255 |
| MLA | ÖZDEMİR Ayşe Zehra,AYAS Bülent,Güven Davut,TÜRKMEN Aysun,Gülümser Çağrı Cost-effectiveness of GnRH antagonist implementation on hCG injection day. Turkish Journal of Obstetrics and Gynecology, vol.16, no.1, 2019, ss.29 - 34. 10.4274/tjod.galenos.2019.56255 |
| AMA | ÖZDEMİR A,AYAS B,Güven D,TÜRKMEN A,Gülümser Ç Cost-effectiveness of GnRH antagonist implementation on hCG injection day. Turkish Journal of Obstetrics and Gynecology. 2019; 16(1): 29 - 34. 10.4274/tjod.galenos.2019.56255 |
| Vancouver | ÖZDEMİR A,AYAS B,Güven D,TÜRKMEN A,Gülümser Ç Cost-effectiveness of GnRH antagonist implementation on hCG injection day. Turkish Journal of Obstetrics and Gynecology. 2019; 16(1): 29 - 34. 10.4274/tjod.galenos.2019.56255 |
| IEEE | ÖZDEMİR A,AYAS B,Güven D,TÜRKMEN A,Gülümser Ç "Cost-effectiveness of GnRH antagonist implementation on hCG injection day." Turkish Journal of Obstetrics and Gynecology, 16, ss.29 - 34, 2019. 10.4274/tjod.galenos.2019.56255 |
| ISNAD | ÖZDEMİR, Ayşe Zehra vd. "Cost-effectiveness of GnRH antagonist implementation on hCG injection day". Turkish Journal of Obstetrics and Gynecology 16/1 (2019), 29-34. https://doi.org/10.4274/tjod.galenos.2019.56255 |
