1. How IVF Protocols Work to Enhance the Success of IVF: Agonist vs Antagonist
Dr Dimitrios Dovas MD
Newlife IVF Greece

2. IDEAL SCENARIO: 1 EGG + 1 SPERM → 1 EMBRYO → PREGNANCY

3. BUT DESPITE MAJOR IMPROVEMENTS IN LAB AND CULTURE MEDIA…
BUT DESPITE MAJOR IMPROVEMENTS IN LAB AND CULTURE MEDIA…. WE NEED MORE THAN 1 EGGS BECAUSE:
SOME FOLLICLES ARE EMPTY
SOME EGGS ARE IMMATURE OR DEGENERATED
SOME MATURE EGGS ARE NOT FERTILISED
SOME EMBRYOS DO NOT DEVELOP TO BLASTOCYSTS
SOME BLASTOCYSTS ARE OF NO GOOD QUALITY

4. HOW MANY EGGS DO WE NEED?
Sunkara et al, HR 2011

5. HOW MANY EGGS DO WE NEED?
Sunkara et al, HR 2011

6. IVF PROGRAMMS 1ST KEY COMPONENT OVARIAN STIMULATION
Recombinant vs urinary gonadotrophins
Long acting FSH vs short acting FSH
Need for additional LH

7. AVOID LH SURGE HENCE OVULATION
IVF PROGRAMMS
2nd KEY COMPONENT
AVOID LH SURGE HENCE OVULATION
GnRH agonist protocols
GnRH antagonist protocols

8. GNRH AGONIST vs ANTAGONIST

9. GNRH AGONIST vs ANTAGONIST
Antagonists
Agonists
Immediate onset of actions (shortens treatment durations)
Prevents hormonal withdrawal symptoms
No recovery time of the pituitary
long pre-treatment
Hormonal (estrogen) withdrawal symptoms through desensitization of pituitary
Recovery of the pituitary gonadotrophin secretion, after stopping the treatment takes about 2 weeks.

10. WHICH PROTOCOLS DO WE EMPLOY

11. AGONIST PROTOCOLS

14. ANTAGONIST PROTOCOLS
Fixed protocol: Initiate antagonist D5 – D6 of stimulation
Flexible protocol: Initiate antagonist when leading follicle 14mm

15. Devroey et al, HR 2009

23. AGONIST vs ANTAGONIST
1-Success rates 2-OHSS 3-Gonadotrophin consumption 4-Length of treatment/compliance 5-Cycle programming 6-Specific groups (PCOS, donors, vitrification of oocytes)

24. NEWLIFE IVF GREECE EXPERIENCE
80% ANTAGONIST
COMPARABLE SUCCESS RATES
REASONS NOT TO USE ANTAGONIST: ENDOMETRIOSIS/ASYNCHRONOUS FOLLICLES EARLY FOLLICULAR PHASE
ABSOLUTE INDICATION FOR ANTAGONIST: PCOS (GNRHa trigger+ aggressive luteal support OR freeze all), DONOR STIMULATION (+GNRHa trigger), OOCYTE VITRIFICATION
FLEXIBILITY IN NATURAL/MODIFIED NATURAL CYCLE PROTOCOLS
IF PROGRAMMING E2 SUPPLEMENTATION AND NOT COCP PROGRAMMING
OBESE PTS ANTAGONIST X2

25. Thank you!!!