RESUMO
At present, there is no agreement on poor ovarian response definition, and no definitive evidence that this prognosis can be changed by a specific protocol. Our data suggest that a flare-up protocol with a depot gonadotropin-releasing hormone (GnRH) agonist formulation gives higher total pregnancy and implantation rates than a GnRH antagonist, possibly by improving oocyte/embryo competence.
Assuntos
Protocolos Clínicos , Desenvolvimento Embrionário/fisiologia , Hormônio Liberador de Gonadotropina/agonistas , Hormônio Liberador de Gonadotropina/antagonistas & inibidores , Oócitos/fisiologia , Indução da Ovulação/métodos , Adulto , Gonadotropina Coriônica/farmacologia , Relação Dose-Resposta a Droga , Transferência Embrionária , Feminino , Humanos , Luteolíticos/farmacologia , Oócitos/efeitos dos fármacos , Gravidez , Taxa de Gravidez , Estudos Retrospectivos , Injeções de Esperma Intracitoplásmicas , Pamoato de Triptorrelina/farmacologiaRESUMO
OBJECTIVE: To compare the effectiveness of vaginal progesterone supplementation with intramuscular supplementation in assisted reproduction cycles. DESIGN: Retrospective study. SETTING: Physiopathology of Human Reproduction Unit, Pordenone, Italy, from July 2000 to June 2004. PATIENT(S): Three hundred and eight-five intracytoplasmic sperm injection (ICSI) procedures (188 with vaginal gel and 197 with intramuscular progesterone) and 373 in vitro fertilization (IVF) cycles (227 with vaginal and 146 with intramuscular progesterone). INTERVENTION(S): Progesterone luteal supplementation: vaginal gel (Crinone 8% 90 mg/day) or intramuscular (Prontogest 50 mg/day). MAIN OUTCOME MEASURE(S): Implantation rates, and total and clinical pregnancy rates. RESULT(S): Higher rates of implantation and total and clinical pregnancies were observed in the vaginal supplemented ICSI subgroup than in the intramuscular one. This difference was observed for all transfers (13.3% vs. 8.8%, 39.8% vs. 23.3%, and 28.7% vs. 18.6%) and for ultrasound-guided transfers (17.2% vs. 9.3%, 49% vs. 27%, and 36.9% vs. 21.1%, respectively). CONCLUSION(S): The vaginal route of luteal supplementation may be better than the intramuscular one, yielding higher implantation rates as well as total and clinical pregnancy rates in ICSI cycles but not in classic IVF treatments.
