Comparison between GnRH agonist and antagonist protocols for severe endometriosis in assisted reproductive cycles

Abstract

Purpose Endometriosis may influence different aspects of reproductive physiology including folliculogenesis, ovulation, embryo quality, and fertilization. Recent data demonstrate that patients with endometriosis-associated infertility undergoing in vitro fertilization (IVF) have a reduction of pregnancy rates compared to women with other indications for IVF. The aim of the study is to evaluate the outcomes of IVF after controlled ovarian hyperstimulation (COH) with GnRH antagonist (GnRH-ant) or GnRH agonist (GnRH-a) in severe endometriosis patients. Methods A total of 101 patients with severe endometriosis undergoing IVF cycles were retrospectively enrolled into two groups in relation to hypothalamic inhibition before COH, obtained respectively with leuprorelin and cetrorelix. We evaluated characteristics of COH and clinical outcomes (overall pregnancy rate, implantation rate, spontaneous miscarriages, ectopic pregnancies, and clinical pregnancy rates). Results The group treated with GnRH-ant presented a similar number of MII oocytes and good quality embryos while using a lower amount of gonadotropins. Outcomes of COH with both GnRH-ant and GnRH-a were similar in patients with stage III-IV endometriosis. The number of retrieved oocytes, the number of obtained embryos, the implantation rates, and the clinical pregnancy rates were similar with GnRH-ant and GnRH-a protocols. Conclusions Considering the pregnancy outcomes, COH with both GnRH-ant and GnRH-a protocols do not present statistical differences in patients with severe endometriosis, but the GnRH-ant protocol could be more convenient in term of gonadotropins amount and patient discomfort.

Effect of endometriosis on implantation rates when compared to tubal factor in fresh non donor in vitro fertilization cycles

“…The number of retrieved oocytes, the number of obtained embryos, the implantation rates and the clinical pregnancy rates were similar with GnRH-ant and GnRH-a protocols. [ 14 ]…”

Comparing ART outcomes in women with endometriosis after GnRH agonist versus GnRH antagonist ovarian stimulation: a systematic review

“…[13][14][15][16][17][18][19][20] In these studies, 1721 cycles used the long GnRHagonist protocol and 1040 cycles used the GnRHantagonist protocol. Six retrospective analyses, [13][14][15][16][17]20 one cross-sectional study 18 and one RCT 19 were identified. Each study was undertaken at a single centre, and all inclusion/exclusion criteria were available.…”

“…Seven studies in the GnRHantagonist arm administered subcutaneous cetrorelix or ganirelix. [13][14][15][16][17][18][19] Five of which followed a flexible multiple dosing protocol 13,[15][16][17]19 and two of which followed a fixed protocol from day 5 or day 6. 14,18 One study also gave patients in the GnRH-antagonist arm an oral contraceptive pill pretreatment taken for 14-24 days in the preceding cycle followed by a 3-to 5-day washout period.…”

“…19 ART outcomes Clinical pregnancy rate. CPR was reported by all eight studies and was calculated by CPR per embryo transfer (ET) in three studies 13,17,18 or CPR per patient/cycle in four studies, [14][15][16]19 (see Table 4). Kolanska et al 20 were the only study to report both CPR per cycle with ET and CPR per patient and analysed fresh/frozen ETs separately.…”

“…Bastu et al 15 Drakopoulos et al 14 Kolanska et al 20 Rodriguez-Purata et al 16 Ruggiero et al 17 Zhao et al 13 Section 1: Internal validity 20 Multivariate logistic regression analysis was performed by two studies which identified maternal age (p = 0.006) and number of embryos (p = 0.03) as main factors that may predict pregnancy rate. 13,18 Live birth rate.…”