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Hum. Reprod. Advance Access originally published online on April 6, 2006
Human Reproduction 2006 21(8):2015-2021; doi:10.1093/humrep/del091
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© The Author 2006. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Comparison of follicular fluid IGF-I, IGF-II, IGFBP-3, IGFBP-4 and PAPP-A concentrations and their ratios between GnRH agonist and GnRH antagonist protocols for controlled ovarian stimulation in IVF-embryo transfer patients

Young Sik Choi1, Seung-Yup Ku1,2, Byung-Chul Jee1, Chang-Suk Suh1,2, Young Min Choi1,2, Jung Gu Kim1, Shin Yong Moon1,2 and Seok Hyun Kim1,2,3

1 Department of Obstetrics and Gynecology, College of Medicine and 2 Institute of Reproductive Medicine and Population, Medical Research Center, Seoul National University, Seoul, Korea

3 To whom correspondence should be addressed at: Department of Obstetrics and Gynecology, College of Medicine, Seoul National University, 28 Yeongeon-Dong, Jongno-Gu, Seoul, 110–744, Korea. E-mail: seokhyun{at}snu.ac.kr

BACKGROUND: Insulin-like growth factors (IGF) and their binding proteins (IGFBP) play a major role in the autocrine and paracrine regulation of folliculogenesis. This is the first study that has compared follicular fluid (FF) IGF-I, IGF-II, IGFBP-3, IGFBP-4 and pregnancy-associated plasma protein (PAPP)-A concentrations, and their ratios, to investigate whether there was any difference in the intrafollicular microenvironment between the GnRH agonist (GnRHa) and antagonist (GnRHant) protocols for controlled ovarian stimulation (COS). METHODS: A total of 68 IVF cycles were included in this study; two groups were studied: GnRHa long protocol group (n = 36) and the flexible GnRHant multiple-dose protocol group (n = 32). FF was obtained from dominant follicles during oocyte retrieval and stored at –70°C until assayed. IGF-I, IGF-II and IGFBP-3 concentrations were measured by radioimmunoassay and IGFBP-4 and PAPP-A by enzyme-linked immunosorbent assay. RESULTS: The duration of COS was significantly longer, and total dose of gonadotrophins used, serum estradiol (E2) levels on hCG day and the number of oocytes retrieved were significantly higher in the GnRHa long protocol group. The concentrations of FF IGF-II and IGFBP-4 were significantly higher, and the ratio of IGF-I/IGFBP-4 was significantly lower in the GnRHa long protocol group. Serum E2 levels per mature follicle were not different between the two groups. CONCLUSIONS: Our data may indicate a difference of intrafollicular microenvironment between cycles using GnRHa long protocols and those using GnRHant protocols. However, the difference in microenvironment does not appear to result in a difference in clinical outcome.

Key words: GnRH agonist and antagonist/IGF/IGFBP/IVF-embryo transfer/PAPP-A


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