Artificial Cycle with or without a Depot Gonadotropin-releasing Hormone Agonist for Frozen-thawed Embryo Transfer: An Assessment of Infertility Type that Is Most Suitable

Abstract

The clinical outcomes of five groups of infertility patients receiving frozen-thawed, cleavage-stage embryo transfers with exogenous hormone protocols with or without a depot gonadotropin-releasing hormone (GnRH) agonist were assessed. A retrospective cohort analysis was performed on 1003 cycles undergoing frozen-thawed, cleavage-stage embryo transfers from January 1, 2012 to June 31, 2015 in the Reproductive Medicine Center of Wuhan General Hospital of Guangzhou Military Region. Based on the infertility etiologies of the patients, the 1003 cycles were divided into five groups: tubal infertility, polycystic ovary syndrome (PCOS), endometriosis, male infertility, and unexplained infertility. The main outcome was the live birth rate. Two groups were set up based on the intervention: group A was given a GnRH agonist with exogenous estrogen and progesterone, and group B (control group) was given exogenous estrogen and progesterone only. The results showed that the baseline serum hormone levels and basic characteristics of the patients were not significantly different between groups A and B. The live birth rates in groups A and B were 41.67% and 29.29%, respectively (P<0.05). The live birth rates in patients with PCOS in groups A and B were 56.25% and 30.61%,respectively (P<0.05). The clinical pregnancy, implantation and on-going pregnancy rates showed the same trends as the live birth rates between groups A and B. The ectopic pregnancy rate was significantly lower in group A than in group B. We concluded that the live birth rate was higher and other clinical outcomes were more satisfactory with GnRH agonist cotreatment than without GnRH agonist co-treatment for frozen-thawed embryo transfer. The GnRH agonist combined with exogenous estrogen and progesterone worked for all types of infertility tested, especially for women with PCOS.

Pregnancy outcome and cost‐effectiveness comparisons of artificial cycle‐prepared frozen embryo transfer with or without GnRH agonist pretreatment for polycystic ovary syndrome: a randomised controlled trial

“…Furthermore, no data were presented on live birth rate. In contrast, however, a larger sample study by Xie and colleagues 14 with many patient subgroups found a significantly higher clinical pregnancy rate, ongoing pregnancy rate, and live birth rate in the PCOS subgroup ( n = 156) receiving GnRH‐a pretreatment than in PCOS patients not receiving GnRH‐ pretreatment. One possible mechanism underlying these reported benefits of GnRH‐a pretreatment for PCOS is suppression of serum LH level, serum E2 level and GnRH–HCG axis function with subsequent inhibition of endometrial inflammation and enhanced expression of endometrial adhesion molecules.…”

“…Although FET is used more frequently than fresh cycle embryo transfer for women with PCOS due to the significantly increased risk of OHSS, 2 little interest has been paid to the development of a suitable endometrial preparation protocol for FET in this clinical population. To date, only two prospective studies (one RCT 17 and one observational study without a comparison group 13 ) and three retrospective studies 13 – 15 have compared endometrial preparation methods for FET in women with PCOS. Among these studies, one RCT 17 and one large sample retrospective study 18 compared ovulation induction and artificial cycle methods using exogenous steroids.…”

“…Therefore, reducing the levels of LH and estrogen, and inhibiting inflammatory factor production by pretreatment with GnRH‐a may be beneficial for embryo implantation in PCOS women. Indeed, a few retrospective studies 13 – 15 have reported benefits of GnRH‐a pretreatment on pregnancy outcomes following AC‐FET for PCOS women, including improved clinical pregnancy rate and lower pregnancy loss rate. However, there is still insufficient evidence to include routine GnRH‐a pretreatment for women with PCOS receiving AC‐FET.…”

Pretreatment With a Long-acting GnRH Agonist in Early Follicular Phase Increases Clinical Pregnancy Rate in Frozen-thawed Embryo Transfer Cycles

“…A 28 days interval between the administration of GnRHa and estrogen was thought to be su cient as the pituitary suppression exerted by GnRHa was relieved upon embryo implantation, wherein the GnRHa-HCG system could play an important role in embryo implantation and development [23]. Palmerola et al administered 1000 mg of leuprolide acetate on day 2 of the cycle.…”

Pregnancy Outcomes Following Letrozole Use in Frozen-thawed Embryo Transfer Cycles: A Systematic Review and Meta-analysis

“…With AC, the time of administering exogenous oestradiol and progesterone and the quantities used can be carefully planned, making clinical arrangements more accurate and flexible. In addition, early ovulation induced by a spontaneous LH surge can be avoided by combining AC with GnRH-a [31]. However, AC is expensive and usually requires daily injections, which can be tedious for both medical staff and patients [32].…”