[The programming of IVF cycles with antagonists].

Area of Science:

• Reproductive Endocrinology
• Assisted Reproductive Technologies (ART)

Background:

• Gonadotrophin-releasing hormone (GnRH) antagonists (cetrorelix, ganirelix) are used in controlled ovarian hyperstimulation to prevent premature luteinizing hormone (LH) surges.
• Unlike GnRH agonists, GnRH antagonists do not promote the homogenization of the developing follicle cohort.

Purpose of the Study:

• To investigate methods for improving the size homogeneity of antral follicles during controlled ovarian hyperstimulation protocols using GnRH antagonists.
• To explore strategies that optimize ovarian response to recombinant follicle-stimulating hormone (r-FSH) and GnRH antagonist protocols.

Main Methods:

• Review of existing literature on GnRH antagonist protocols in ART.
• Analysis of the effects of pre-treatment with estrogens, progestogens, or oral contraceptive pills during the late luteal phase on follicle development.
• Evaluation of the potential impact of improved follicle size homogeneity on ovarian response.

Main Results:

• GnRH antagonists effectively prevent premature LH surges but do not inherently lead to uniform follicle growth.
• Pre-treatment strategies involving estrogens, progestogens, or contraceptive pills may enhance the size homogeneity of antral follicles.
• Coordinated follicular development is hypothesized to optimize the ovarian response to combined r-FSH/GnRH antagonist stimulation.

Conclusions:

• While GnRH antagonists are crucial for preventing premature ovulation, additional strategies are needed to improve follicle cohort homogeneity.
• Hormonal pre-treatment in the late luteal phase presents a potential method to achieve more uniform follicle development.
• Optimizing follicle size coordination may lead to improved outcomes in assisted reproductive technologies utilizing GnRH antagonist protocols.