The introduction of GnRH antagonists in ART has altered significantly the clinician’s approach to ovarian stimulation. This due to the presence of major differences between GnRH agonists and antagonists regarding the conduct and safety of stimulation and the burden imposed to the patient. The availability of GnRH antagonists for suppressing premature LH surges has thus generated enormous interest in the scientific community, last not least because the vast majority of IVF patients are still exposed to ovarian stimulation and prominent issues of distress and safety of IVF pertain to the two weeks before oocyte pick-up. On Dec 10, 2004, five years after the introduction of Antagonists into routine clinical practice, the SIG reproductive endocrinology had organized a Consensus workshop in Brussels, from which a frequently cited report published in Human Reproduction 2006 originated. Meanwhile, a large number of studies on GnRH-antagonist ovarian stimulation, including several systematic reviews and meta-analyses, have been performed, and it was high time to comprehensively review all relevant topics providing an update for the practising clinician, while highlighting future directions for the clinical researcher. Many faculty members from the 2004 event were around again at the workshop held in Hamburg, Germany (picture), presenting the latest data and views of their subspecialty, and sharing their thoughts with a highly interactive audience.
While the conclusion in 2004 regarding OHSS reduction with Antagonist was that the “effects of GnRH antagonist co-treatment on the incidence of ovarian hyperstimulation syndrome remains uncertain”, all participants in 2012 agreed on the basis of a large number of solid RCTs that Antagonist co-treatment drastically reduces the risk of severe OHSS, as both Prof. Mohamed Aboulghar (Cairo, Egypt) and Prof. Efstratios Kolibianakis (Thessaloniki, Greece) pointed out after a short introduction on the history of antagonist development (Klaus Diedrich, Luebeck, Germany).
A full session was devoted to new concepts in ovarian stimulation: Nick Macklon (Southampton, UK) gave a visionary talk on the potential association of ovarian stimulation and adverse outcomes and shared his latest data on the embryo-endometrium crosstalk in IVF. Peter Humaidan (Skive, Denmark) summarized the exciting promise that Agonist triggering holds in replacing hCG as the signal for final oocyte maturation, and Paul Devroey (Brussel, Belgium), one of the key players in Antagonist research in the last 15 years, advocated the concept of segmentation of IVF treatment, e.g. temporally splitting the phase of stimulation from embryo transfer and early pregnancy. Further lectures dealt with the endogenous hormones during stimulation (Human Fatemi, Brussels, Belgium), endometrial receptivity (Claire Bourgain, Brussels), Gonadotropin regimen in Antagonist protocols (Basil Tarlatzis, Thessaloniki) and treatment scheduling (Georg Griesinger, Luebeck, Germany). Finally, Cornelius Lambalk from Amsterdam spoke on the place of GnRH-antagonists in the context of intra-uterine insemination and Frank Broekmans (Utrecht, Netherlands) tackled with the question how to predict response to gonadotropin stimulation in GnRH-antagonist protocols.
During the course of the workshop it became clear how much progress has really been achieved by applying evidence based medicine measures to clinical research in ovarian stimulation. With approx 100 participants in the audience, this workshop provided an ideal sized forum for interaction and debates between audience and faculty.
Faculty of the GnRH-antagonist workshop in Hamburg, 28. Sept 2012
From left to right background: Daniela Romualdi, Klaus Diedrich, Basil Tarlatzis, Nils Lambalk, Efstratios Kolibianakis, Frank Broekmans, Nick Macklon, Peter Humaidan, Claire Bourgain; front row: Mohamed Aboulghar, Paul Devroey, Human Fatemi, Georg Griesinger