The aptness of antagonistic protocol in intracytoplasmic sperm injection: Embryologic study


  • Tuqa Yousif Sharef Department of Basic Science, College of Dentistry, Hawler Medical University, Erbil, Iraq



GnRH antagonist, Intracytoplasmic sperm injection stimulation, IVF protocol


Background and objective: Infertility and poor ovarian response are serious problems in our society; fortunately the in vitro fertilization and intracytoplasmic sperm injection technique dissolve many of these problems. This study aimed to assess the effect of an individualized GnRH antagonist regimen on intracytoplasmic sperm injection process especially the aptness of it in given mature reiterative oocytes, normal fertilization, and acceptably zygote cleavage which enhance pregnancy.

Methods: The population of the study consisted of 877 couples attending the in vitro fertilization-infertility center in the maternity teaching hospital and chose to undergo intracytoplasmic sperm injection after using of antagonist protocol for stimulation of women ovaries. The women ages ranged between 24 and 44 years. The collected data included a number of reiterative oocytes; fertilization, embryo grades and lastly estimates the pregnancy results

Results: A significant association (P <0.001) was found in the numbers of reiterative oocytes between the age groups of the study. A significant association (P = 0.005) was also found concerning to quality of fertilization process. The study of the zygote cleavage and blastomeres formation followed the fertilization show variable grade of embryos and analyzed data of embryo grades in this study indicate presence of significant association (P = 0.003). The rate of pregnancy showed significant association between the groups of the study with the <30 years age group have chance of pregnancy higher than other groups.

Conclusion: The antagonist protocol of ovary stimulation according to the results of this study is a qualified protocol; besides it is rapid and can be reversed. This protocol can give effective results in the intracytoplasmic sperm injection process especially for young women, and enhance the pregnancy.


Metrics Loading ...


Al-Inany HG, Abou-Setta AM, Aboulghar M. Gonadotrophin-releasing hormone antagonists for assisted conception. Cochrane Database Syst Rev 2006; 3:CD001750.

Cousineau TM, Domar AD. Psychological impact of infertility. Best Pract Res Clin Obstet Gynaecol 2007; 21:293–308.

Ragni G, Vegetti W, Riccaboni1 A, Engl B, Brigante C, Crosignani PG. Comparison of GnRH agonists and antagonists in assisted reproduction cycles of patients at high risk of ovarian hyperstimulation syndrome. Hum Reprod 2005; 20:2421–5.

Mochtar MH, Van der Veen F, Ziech M, van Wely M. Recombinant luteinizing hormone (rLH) for controlled ovarian hyperstimulation in assisted reproductive cycles. Cochrane Database Syst Rev 2007; 2:CD005070.

Hillier SG. Gonadotropic control of ovarian follicular growth and development. Mol Cell Endocrinol 2001; 179:39–46.

Lin H, Yu L, Li L, Wang W, Dongzi Y, Zhang Q. Is a GnRH Antagonist Protocol Better in PCOS Patients? A Meta-Analysis of RCTs. PLOS ONE 2014; 9(3):e91796.

Aygun BK, Kahraman S. Comparison of GnRH Agonist Long and Antagonist Protocols in the Same Normoresponder Patient Undergoing Assisted Reproductive Treatment. Fırat Tıp Dergisi 2010; 15(3):123–7.

Ioannidis G, Sacks G, Reddy N, Seyani L, Margara R, Lavery S, et al. Day 14 maternal serum progesterone levels predict pregnancy outcome in IVF/ICSI treatment cycles: a prospective study. Hum Reprod 2005; 20(3):741–6.

Fischl F, Nicollet B, Beher HM, Van der Ven H, Simon A, Kilani Z, et al. The European and Middle East orgalturan, study group. Comparable clinical outcome using the GnRH antagonist ganirelix or a long protocol of the GnRH agonist triptorelin for the prevention of premature LH surges in women undergoing ovarian stimulation. Hum Reprod 2001; 16;644–51.

Mochtar MH. The effect of an individualized GnRH antagonist protocol on folliculogenesis in IVF/ICSI. Hum Reprod 2004; 19(8):1713–8.

Borm G, Mannaerts B. Treatment with the gonadotropin-releasing hormone antagonist ganirelix in women undergoing controlled ovarian hyperstimulation with recombinant follicle stimulating hormone is effective, safe and convenient: results of controlled, randomized, multicentre trial. The European Orgalutran Study Group. Hum Reprod 2000; 15:1490–8.

Al-Inany HG, Abou-Setta AM, Aboulghar M. Gonadotrophin-releasing hormone antagonists for assisted conception: a Cochrane review. Reprod Biomed Online 2007; 14:640–9.

Diedrich K, Diedrich C, Santos E, Zoll C, al-Hasani S, Reissmann T, et al. Suppression of the endogenous LH-surge by the LH-RH antagonist Cetrorelix during ovarian stimulation. Hum Reprod 1994; 9:788–91.

Itskovitz-Eldor J, Kol S, Mannaerts B. Use of a single bolus of GnRH agonist triptorelin to trigger ovulation after GnRH antagonist ganirelix treatment in women undergoing ovarian stimulation for assisted reproduction, with special reference to the prevention of ovarian hyperstimulation syndrome: preliminary report: short communication. Hum Reprod 2000; 15:1965–8.

Fauser BC, de Jong D, Olivennes F, Wramsby H, Tay C, Itskovitz-Eldor J, et al. Endocrine profiles after triggering of final oocyte maturation with GnRH agonist after cotreatment with the GnRH antagonist ganirelix during ovarian hyperstimulation for in vitro fertilization. J Clin Endocrinol Metab 2002; 87:709–15.

Olivennes F, Fanchin R, Bouchard P, Taieb J, Frydman R. Triggering of ovulation by a gonadotropin-releasing hormone (GnRH) agonist in patients pretreated with a GnRH antagonist. Fertil Steril 1996; 66:151–3.

Ludwig M, Katalinic A, Banz C, Schroder AK, Loning M, Weiss JM, et al. Tailoring the GnRH antagonist cetrorelix acetate to individual patients’ needs in ovarian stimulation for IVF: results of a prospective randomized study. Hum Reprod 2002; 17:2842–5.

Beckers NG, Macklon NS, Eijkemans MJ, Ludwig M, Felberbaum RE, Diedrich K, et al. Nonsupplemented luteal phase characteristics after the administration of recombinant human chorionic gonadotropin, recombinant luteinizing hormone, or gonadotropin-releasing hormone (GnRH) agonist to induce final oocyte maturation in in vitro fertilization patients after ovarian stimulation with recombinant follicle-stimulating hormone and GnRH antagonist cotreatment. J Clin Endocrinol Metab 2003; 88:4186–92.

Griesinger G, Felberbaum R, Diedrich K. GnRH antagonists in ovarian stimulation: a treatment regimen of clinicians’ second choice? Data from the German national IVF registry. Hum Reprod 2005; 20:2373–5.

Macklon NS, Stouffer RL, Giudice LC, Fauser BC. The science behind 25 years of ovarian stimulation for in vitro fertilization. Endocr Rev 2006; 27:170–207.

Huirne JA, Homburg R, Lambalk CB. Are GnRH antagonists comparable to agonists for use in IVF? Hum Reprod 2007; 22:2805–13.




How to Cite

Sharef, T. Y. (2019). The aptness of antagonistic protocol in intracytoplasmic sperm injection: Embryologic study. Zanco Journal of Medical Sciences (Zanco J Med Sci), 23(1), 28–34.



Original Articles