Value of Cabergoline and Low Dose Aspirin in Poor Responders Undergoing ICSI-ET Using Microdose GNRH Agonist Flare-Up-Protocol

Document Type : Original Article

Authors

1 Obstetrics and Gynecology department, faculty of medicine, Cairo University

2 Misr University for Science & Technology

3 Obstetrics and Gynecology department, faculty of medicine, Cairo University1

Abstract

Introduction: The aim of this study was to investigate pregnancy outcomes and live birth rate of vaginal progesterone gel protocol administered alone and and vaginal progesterone gel together with oral dydrogesterone protocol to provide luteal phase support in women undergoing vitro fertilization-intracytoplasmic sperm injection (IVF-ICSI).
Materials and Methods: This prospective, randomized, single blinded study was done in Kasr EI-Aini fertility and infertility center of Cairo University. The aim of the study was to determine the effect of cabergoline and low dose aspirin in poor responders undergoing ICSI-ET using microdose GnRH flare up protocol. The study involved 60 women referred to the center with the history of one or more failed IVF cycles with three or less retrieved oocytes. All women were assessed prior to inclusion with careful history taking, general examination and abdominal examination, and hormonal profile. Transvaginal ultrasound (TVUS) examination was done to assess antral follicle count (AFC). The 60 participants were allocated randomly into one of three treatment groups: CAB group (n=20) received cabergoline in a dose of 1 mg/week in two divided doses and low dose aspirin 80 mg/day, Aspirin group (n=20) received only aspirin as in CAB group and GnRH Group (n=20) received the microdose GnRH protocol only without any additive drugs.Ovarian stimulation was done using the Microdose flare-up regimen starting with the GnRH agonist leuprolide acetate 40 μg subcutaneously followed by stimulation with intramuscular injections of HMG in a daily dose of 300 IU/day. When at least 2 follicles 18 mm were observed on follicular monitoring, 10000 IU HCG were injected intramuscularly. Oocytes were retrieved 36 hours after hCG injection. After fertilization was confirmed, one to three grade A embryos were transferred at day 3 fertilization. Luteal phase support was then initiated from the day of oocyte retrieval for all patients. The primary outcome measure was the number of retrieved oocytes. The secondary outcome measures were number of fertilized oocytes, number of embryos transferred and ongoing pregnancy rate.
Results: The three groups were comparable in age (p = 0.509), body mass index (p = 0.221) and duration of infertility (p = 0.889). There was no significant difference between the three groups in the levels of FSH, LH and ANH (p = 0.808, 0.198, and 0.867). There was no significant difference between the three groups in the number of retrieved and fertilized oocytes (p = 0.852 and 0.990, respectively). Ongoing pregnancy was detected in 2 women (10%) of CAB group, 3 women (15%) of Aspirin group and 2 women (10%) in GnRH group with no significant difference between the three groups (p = 1.000).
Conclusions: In conclusion, the use of GnRH flare-up protocol in patients with poor ovarian response undergoing ICSI cycles achieved a pregnancy rate of 15%. The addition of low-dose aspirin to this protocol did not improve pregnancy rate in these cases. The triple therapy with cabergoline, aspirin and microdose GnRH was not effective in poor ovarian responders.

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