How IVF Protocols Work to Enhance the Success of IVF: Agonist vs Antagonist Dr Dimitrios Dovas MD Newlife IVF Greece

IDEAL SCENARIO: 1 EGG + 1 SPERM → 1 EMBRYO → PREGNANCY

BUT DESPITE MAJOR IMPROVEMENTS IN LAB AND CULTURE MEDIA… BUT DESPITE MAJOR IMPROVEMENTS IN LAB AND CULTURE MEDIA…. WE NEED MORE THAN 1 EGGS BECAUSE: SOME FOLLICLES ARE EMPTY SOME EGGS ARE IMMATURE OR DEGENERATED SOME MATURE EGGS ARE NOT FERTILISED SOME EMBRYOS DO NOT DEVELOP TO BLASTOCYSTS SOME BLASTOCYSTS ARE OF NO GOOD QUALITY

HOW MANY EGGS DO WE NEED? Sunkara et al, HR 2011

HOW MANY EGGS DO WE NEED? Sunkara et al, HR 2011

IVF PROGRAMMS 1ST KEY COMPONENT OVARIAN STIMULATION Recombinant vs urinary gonadotrophins Long acting FSH vs short acting FSH Need for additional LH

AVOID LH SURGE HENCE OVULATION IVF PROGRAMMS 2nd KEY COMPONENT AVOID LH SURGE HENCE OVULATION GnRH agonist protocols GnRH antagonist protocols

GNRH AGONIST vs ANTAGONIST

GNRH AGONIST vs ANTAGONIST Antagonists Agonists Immediate onset of actions (shortens treatment durations) Prevents hormonal withdrawal symptoms No recovery time of the pituitary long pre-treatment Hormonal (estrogen) withdrawal symptoms through desensitization of pituitary Recovery of the pituitary gonadotrophin secretion, after stopping the treatment takes about 2 weeks.

WHICH PROTOCOLS DO WE EMPLOY

AGONIST PROTOCOLS

ANTAGONIST PROTOCOLS Fixed protocol: Initiate antagonist D5 – D6 of stimulation Flexible protocol: Initiate antagonist when leading follicle 14mm

Devroey et al, HR 2009

AGONIST vs ANTAGONIST 1-Success rates 2-OHSS 3-Gonadotrophin consumption 4-Length of treatment/compliance 5-Cycle programming 6-Specific groups (PCOS, donors, vitrification of oocytes)

NEWLIFE IVF GREECE EXPERIENCE 80% ANTAGONIST COMPARABLE SUCCESS RATES REASONS NOT TO USE ANTAGONIST: ENDOMETRIOSIS/ASYNCHRONOUS FOLLICLES EARLY FOLLICULAR PHASE ABSOLUTE INDICATION FOR ANTAGONIST: PCOS (GNRHa trigger+ aggressive luteal support OR freeze all), DONOR STIMULATION (+GNRHa trigger), OOCYTE VITRIFICATION FLEXIBILITY IN NATURAL/MODIFIED NATURAL CYCLE PROTOCOLS IF PROGRAMMING E2 SUPPLEMENTATION AND NOT COCP PROGRAMMING OBESE PTS ANTAGONIST X2

Thank you!!!