COMPARATIVE CHARACTERISTICS OF PROTOCOLS OF OVULATION STIMULATION WITH USING OF AGONISTS AND ANTAGONISTS OF GONADOTROPIN-RELEASING HORMONE IN THE PROGRAMS OF ASSISTED REPRODUCTIVE TECHNOLOGIES (LITERATURE REVIEW)
DOI:
https://doi.org/10.11603/1681-2786.2018.4.10036Keywords:
infertility, assisted reproductive technologies, extracorporal fertilization, intracytoplasmatic sperm injection, controlled ovarian stimulation, gonadotropin-releasing hormone agonist, gonadotropin-releasing hormone antagonist, ovulation trigger, poor responders, polycystic ovary syndromeAbstract
Purpose: to conduct an analysis of modern domestic and foreign literature about protocols of ovulation stimulation using GnRH agonists and antagonists during programs of assisted reproductive technologies; evaluate their effectiveness and safety; compare the advantages and disadvantages of each of them.
Materials and Methods. Bibliosemantic and analytical methods were used in the study. During the study, 23 sources of modern domestic and foreign literature were reviewed and analyzed on the selection of an optimal protocol for controlled ovulation stimulation in cycles of extracorporal fertilization.
Results. Controlled ovarian stimulation is the first and one of the most important stages of extracorporal fertilization. The tactic of choosing the optimal protocol for controlled ovulation stimulation should be strictly individual. Nowadays there are many types of superovulation stimulation protocols in patients undergoing infertility treatment in IVF programs. Each of these protocols has its advantages and disadvantages, but the most commonly used in clinical practice are protocols of stimulation of superovulation using agonists and antagonists of GnRH. Although the question about the mechanism of action of agonists and antagonists of GnRH is well known, but there is still no clear answer as to which analogue gives better results in clinical practice.
Conclusions. Protocols with antagonists of gonadotropin-releasing hormone are significantly safer, since their using significantly reduces the incidence of ovarian hyperstimulation syndrome due to the possibility of maneuvering with choosing of trigger. It is more comfortable for patients due to shorter duration and lower cost of stimulation of ovulation. It is effective in women with poor responders and the presence of polycystic ovary syndrome. Instead, during using of long protocols with GnRH agonists, a higher incidence of pregnancy was observed.
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