Relationship of the results of ovulation induction with Antagonist GnRH regimen (cetrotite) in patients with poor ovarian response in previous ART

Document Type : Original Article


1 Assistant Professor, Department of Obstetrics and Gynecology, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran.

2 Resident of Obstetrics and Gynecology, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran.


Introduction: Using ovulation induction regimen antagonist has been recently suggested in Infertility centers for resolving of the problems of the patients with poor ovarian response. The antagonist regime is selected in this study because it has low cost, it takes shorter time to obtain the results and has not been used so far in this center. Therefore, this study was performed with aim to evaluate and compare the results of ovulation induction with Antagonist GnRH regimen (cetrotite) in patients with poor ovarian response in previous ART (Assisted Reproductive Technique).
Methods: This interventional and experimental study which had no control group was performed on 41 infertile women by before and after plan in Kerman Afzalpour hospital infertility center from 2013-2014. People with poor ovarian response in previous ART cycles were selected and underwent antagonist regimen in new cycle. Then, the results of previous and current cycle of the patients including the number of follicles, number of oocytes, oocyte quality, the number of embryo and embryo quality were compared. Data was analyzed by SPSS software (version 16) and chi-square test and paired t-test or nonparametric equivalents. P<0.05 was considered statistically significant.
Results: The number of follicles, oocyte quality, endometrial thickness, grading, the number of transferred embryo, and the number of pregnancy in the previous regime had no significant relationship with Antagonist regime (P>0.001). But significant difference was observed in terms of the number of oocytes and the number of embryos in antagonist regimen.
Conclusion: Ovulation induction with antagonist regimen is a good choice for poor ovarian response patients.


  1. Pu D, Wu J, Liu J. Comparisons of GnRH antagonist versus GnRH agonist protocol in poor ovarian responders undergoing IVF. Hum Reprod 2011; 26(10): 2742-9.
  2. Bendikson K, Milki AA, Speck-Zulak A, Westphal LM. Comparison of GnRH antagonist cycles with and without oral contraceptive pill pretreatment in poor responders. Clin Exp Obstet Gynecol. 2006;33(3):145-7.
  3. Zhang HJ, Song XR, Lü R, Xue FX. Modified super-long down-regulation protocol improves fertilization and pregnancy in patients with poor ovarian responses.Chin Med J 2012;125(16):2837-40.
  4. Olivennes F. The use of gonadotropin-releasing hormone antagonist in ovarian stimulation. Clin Obstet Gynecol 2006;49(1):12-22.
  5. Ferraretti AP, La Marca A, Fauser BC, Tarlatzis B, Nargund G, Gianaroli L, et al. ESHRE consensus on the definition of ‘poor response' to ovarian stimulation for in vitro fertilization: the Bologna criteria. Hum. Reprod 2011;26(7):1616-24.
  6. Keay SD, Liversedge NH, Mathur RS, Jenkins JM. Assisted conception following poor ovarian reponse to gonadotrophin stimulation. Br J Obstet Gynaecol 1996;104(5):521-7.
  7. Berin I, Stein DE, Keltz MD. A comparison of gonadotropin-releasing hormone (GnRH) antagonist and GnRH agonist flare protocols for poor responders undergoing in vitro fertilization. FertiSteril. 2010;93(2):360-3.
  8. Humaidan P, Bungum L, Bungum M, Hald F, Agerholm I, Blaabjerg J, et al. Reproductive outcome using a GnRH antagonist (cetrorelix) for luteolysis and follicular synchronization in poor responder IVF/ICSI patients treated with a flexible GnRH antagonist protocol. Reprod Biomed Online 2005; 11(6):679-84.
  9. Noorashikin M, Ong FB, Omar MH, Zainul-Rashid MR, Murad AZ, Shamsir A, et al. Affordable ART for developing countries: a cost benefit comparison of low dose stimulation versus high dose GnRH antagonist protocol. J Assist Reprod Genet 2008; 25(7):297-303.
  10. Firouzabadi RD, Ahmadi S, Oskouian H, Davar R. Comparing GnRH agonist long protocol and GnRH antagonist protocol in outcome the first cycle of ART. Arch Gynecol Obstet 2010; 281(1):81-5.
  11. Tehraninejad E, Ghahghaei Nezamabadi A, Rashidi B, Sohrabi M, Bagheri M, Haghollahi F. GnRH antagonist versus agonist in normoresponders undergoing ICSI: a randomized clinical trial in Iran. Iran J Reprod Med 2011; 9(3):171-6.
  12. Ludwig M, Schopper B, Katalinic A, Sturm R, Al-Hasani S, Diedrich K. Experience with the elective transfer of two embryos under the conditions of theGerman embryo protection law: results of a retrospective data analysis of 2573 transfer cycles. Hum Reprod 2000; 15(2):319–24.
  13. Prapas Y, Petousis S, Dagklis T, Panagiotidis Y, Papatheodorou A, Assunta I, et al. GnRH antagonist versus long GnRH agonist protocol in poor IVF responders: a randomized clinical trial. Eur J Obstet Gynecol Reprod Biol 2013; 166(1):43-6.
  14. Eftekhar M, Firouzabadi RD, Karimi H, Rahmani E. Outcome of cryopreserved-thawed embryo transfer in the GnRH agonist versus antagonist protocol. Iran J Reprod Med 2012; 10(4):297-302.
  15.   Revelli A, Piane L, Casano S, Molinari E, Massobrio M, Rinaudo P. Follicular fluid content and oocyte quality: from single biochemical markers to metabolomics. Reprod Biol Endocrinol 2009; 7: 40.
  16.  Choi D, Hwang S, Lee E, Park C, Yoon B, Lee J, et al. Recombinant FSH and pregnancy-associated plasma protein. Eur J Obstet Gynecol Reprod Biol 2003; 109(2): 171-6.
  17. Aflatoonian  A,  Mashayekhy  M,  Mohamadian  F, Mansoori Moghaddam M. The correlation between follicular fluid anti-mullerian hormone levels and fertilization and embryo quality in ART cycles. Iran J Reprod Med 2010; 8(4): 157-60.
  18. Brus L, Lambalk C, De Koning J, Helder M, Janssens R, Schoemaker J. Specific gonadotrophin-releasing hormone analogue binding predominantly in human luteinized follicular aspirates and not in human preovulatory follicles. Hum Reprod 1997; 12(4): 769-73.
  19. Choi YS, Ku SY, Jee BC, Suh CS, Choi YM, Kim JG, et al. , (2006) Comparison of follicular fluid IGF-I, IGF-II, IGFBP-3, IGFBP-4 and PAPP-A concentrations and their ratios between GnRH agonist and GnRH antagonist protocols for controlled ovarian stimulation in IVF-embryo transfer patients. Hum Reprod; 21: 2015-2021.
  20. Funston RN, Seidel GE Jr. Gonadotropin-releasing hormone increases cleavage rates of bovine oocytes fertilized in vitro. Biol Reprod 1995; 53(3): 541-5.
  21. Detti L, Ambler DR, Yelian FD, Kruger ML, Diamond MP, Puscheck EE. Timing and duration of use of GnRH antagonist down-regulation for IVF/ICSI cycles have no impact on oocyte quality or pregnancy outcomes. J Assist Reprod Genet 2008;25(5):177-81.
  22. Valbuena D, Martin J, de Pablo JL, Remohi J, Pellicier A, SimonC. Increasing levels of estradiol are deleterious to embryonic implantation because the directly affect the embryo. Fertil Steril 2001;76(5):962–8.
  23. Marci R, Casert, D, Dolo V, Tatone C, Pavan A, Moscarini M. GnRH antagonist in IVF poor  responder patients. Reprod Biomed Online 2005;11(2):189-93.