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<p>After the so-called “long protocol” using gonadotropin-releasing hormone (GnRH) agonists was the gold standard in controlled ovarian stimulation until the turn of the millennium, the market launch of peptide GnRH antagonists heralded a&#xa0;new era in the treatment of involuntarily childless couples. The fact that GnRH antagonists are only used when there is a&#xa0;risk of a&#xa0;premature luteinizing hormone (LH) surge, i.e., premature ovulation, led to a&#xa0;significant shortening of the stimulation time and the necessary amount of gonadotropins to be administered. Additionally, this treatment modality reduced the risk of higher-grade ovarian hyperstimulation syndrome (OHSS). Since the 1920s, over 80% of all treatments worldwide have been carried out according to the multiple dose antagonist protocol developed in Bonn and Lübeck. The introduction of the peptide GnRH antagonists was a&#xa0;real game changer. This is also due to the fact that the final follicle maturation can be triggered with a&#xa0;low dose of a&#xa0;GnRH agonist, which is not possible with the so-called “long protocol”. However, there is still a&#xa0;discussion about the efficiency of the “GnRH antagonist multiple dose protocol” compared to the “GnRH agonist long protocol”. Large meta-analyses show equivalence in terms of the “live birth rate”, while the number of “cumulus oocyte complexes” obtained and the resulting “high-grade embryos” is somewhat lower. The clinical results of the so-called “fixed protocol”, in which the GnRH antagonist is always started on the 6th&#xa0;day of stimulation, are equivalent to the so-called “flexible protocol”. If final follicle maturation is triggered with a&#xa0;GnRH agonist, the time interval until follicle puncture can vary between 32&#xa0;and 40 h without negatively affecting treatment outcome.</p>

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Das Antagonistenprotokoll bei der ovariellen Stimulation

  • 期刊论文

  • 发表日期：

    2025年7月29日

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  • Ricardo Felberbaum,
  • Wolfgang Küpker,
  • Anke Brössner,
  • Klaus Diedrich

摘要

After the so-called “long protocol” using gonadotropin-releasing hormone (GnRH) agonists was the gold standard in controlled ovarian stimulation until the turn of the millennium, the market launch of peptide GnRH antagonists heralded a new era in the treatment of involuntarily childless couples. The fact that GnRH antagonists are only used when there is a risk of a premature luteinizing hormone (LH) surge, i.e., premature ovulation, led to a significant shortening of the stimulation time and the necessary amount of gonadotropins to be administered. Additionally, this treatment modality reduced the risk of higher-grade ovarian hyperstimulation syndrome (OHSS). Since the 1920s, over 80% of all treatments worldwide have been carried out according to the multiple dose antagonist protocol developed in Bonn and Lübeck. The introduction of the peptide GnRH antagonists was a real game changer. This is also due to the fact that the final follicle maturation can be triggered with a low dose of a GnRH agonist, which is not possible with the so-called “long protocol”. However, there is still a discussion about the efficiency of the “GnRH antagonist multiple dose protocol” compared to the “GnRH agonist long protocol”. Large meta-analyses show equivalence in terms of the “live birth rate”, while the number of “cumulus oocyte complexes” obtained and the resulting “high-grade embryos” is somewhat lower. The clinical results of the so-called “fixed protocol”, in which the GnRH antagonist is always started on the 6th day of stimulation, are equivalent to the so-called “flexible protocol”. If final follicle maturation is triggered with a GnRH agonist, the time interval until follicle puncture can vary between 32 and 40 h without negatively affecting treatment outcome.