"Mild" vs. "long" protocol for controlled ovarian hyperstimulation in patients with expected poor ovarian responsiveness undergoing in vitro fertilization (IVF): a large prospective randomized trial.

BACKGROUND: This large prospective, randomized study was designed to compare the "mild" protocol with clomiphene citrate, low-dose gonadotropins and a GnRH-antagonist (CC/Gn/GnRH-ant protocol) with the "long" protocol with a GnRH-agonist and high-dose Gn for the controlled ovarian hyperstimulation (COH) of patients with expected poor ovarian responsiveness undergoing IVF. MATERIALS AND METHODS: A total of 695 women with clinical, endocrine and ultrasound characteristics suggesting a low ovarian reserve and a poor responsiveness to COH were recruited and randomly assigned to receive the CC/Gn/GnRH-ant "mild" protocol (mild group, n = 355) or the "long" protocol with high-dose Gn (long group, n = 340). RESULTS: The "mild" stimulation led to significantly shorter follicular phase, lower consumption of exogenous Gn and lower peak estradiol level than the "long" regimen. With the "long" protocol, significantly less cycles were cancelled due to the lack of ovarian response; further, it obtained significantly more oocytes, more mature oocytes, more embryos, and a thicker endometrium. As for the final IVF outcome, however, the two stimulation regimens obtained comparable implantation rate, clinical pregnancy rate, and ongoing pregnancy rate at 12 weeks. CONCLUSIONS: In conclusion, the "mild" CC/Gn/GnRH-ant stimulation protocol is a valid alternative to the long protocol with high Gn dose as it obtains a comparable success rate and requires significantly less medications, with an obvious economical advantage.

17beta-estradiol induces Akt-1 through estrogen receptor-beta in the frog (Rana esculenta) male germ cells.

Several lines of evidence support the key role of estrogens in male fertility. Here, we investigate the regulation of the serine/threonine kinase Akt-1 in the frog (Rana esculenta) testis during the annual sexual cycle and, whether 17beta-estradiol (E2) exerts a role in the Akt-1 activity. Akt-1 has been shown to be the mediator of growth factor-dependent cell proliferation, survival, and metabolism in a variety of cell types. First, we demonstrate by immunohistochemistry, the presence of estrogen receptor-beta (ERbeta), and Akt-1 in the spermatogonia (SPG), spermatocytes (SPC), and spermatids (SPT). Western-blot analysis revealed that ERbeta isoform (molecular weight 55 kDa) was highly expressed in May (reproductive period) with respect to January and November (winter stasis); in parallel, Akt-1 (molecular weight 60 kDa) is highly phosphorylated (Ser-473) during the period of active spermatogenesis (May) compared with the winter stasis (January and November). In addition, in vitro experiments demonstrate that E2 treatment induces the activation of Akt-1, and this effect is counteracted by the anti-estrogen ICI 182-780. In conclusion, our data show that E2 induces Akt-1 phosphorylation (Ser-473) possibly via ERbeta in frog (R. esculenta) male germ cells.