Early GnRH antagonist administration improves oocyte and embryo quality and reduces embryo cleavage errors
Mona Ghamloush (LB), Georges Raad (LB), Joan Azoury (LB), Liliane Jalbout (LB), Jessica Azoury (LB), Joseph Azoury (LB)
[Ghamloush] Azoury IVF Clinic mount Lebanon Hospital, [Raad] Azoury IVF Clinic mount Lebanon Hospital, [Azoury] Azoury IVF Clinic mount Lebanon Hospital, [Jalbout] Azoury IVF Clinic mount Lebanon Hospital, [Azoury] Azoury IVF Clinic mount Lebanon Hospital, [Azoury] Azoury IVF Clinic mount Lebanon Hospital
CONTEXT: Single site fertility clinic in Beirut, Lebanon OBJECTIVE: To study the impact of a short and early Gonadotropin Releasing Hormone (GnRH) antagonist administration on oocyte quality and early embryo morpho-kinetics. METHODS: Retrospective analysis of collected database. PATIENT(S): A total of 334 infertile couples underwent an intra-cytoplasmic sperm injection (ICSI) cycle. 258 patients received the “conventional” antagonist protocol and 76 received the “Sandwich” antagonist protocol that consists in the administration of GnRH antagonist for 3 days before starting ovarian stimulation. MAIN OUTCOME MEASURE(S): Oocyte and embryo morphological characteristics as well as embryo cleavage errors recurrence were analyzed using the Embryo-viewer Software (Vitrolife) to assess their quality. RESULT(S): The number of oocytes (8.3 ± 6.22 vs. 6.9 ± 4.5; P<0.05) and 2PN embryos obtained (4 ± 2.8 vs. 3.04 ± 2.5; P=0.006) were significantly higher in the Sandwich protocol group. The Oocytes in the control group had a significantly larger first polar body (368 ± 121.7 vs. 335 ± 102.9; P=0.0253), a higher percentage of cytoplasmic granularity (95.4% vs. 36.6%; P<0.0001) and PVS debris (47.1% vs. 34.4%; P=0.04) compared to the oocytes in the study group. 99 and 271 embryos, from study and control group respectively, were assessed using time-lapse monitoring. The synchronization of the second cleavage rate (33.7% vs. 15.4%; P=0.0027) and the blastulation rate (68.75% ± 32.8% vs. 42.11% ± 32.54%; P=0.0005) were significantly higher in the Sandwich protocol group. Embryo cleavage errors (4.04% vs. 15.9%; P=0.0014) were significantly reduced in the Sandwich protocol group. CONCLUSION: The administration of GnRH antagonist for 3 days before starting ovarian stimulation significantly enhances oocyte and embryo quality and reduces the recurrence of embryo cleavage errors.