Effects of multiple doses of gonadotropin-releasing hormone agonist on the luteal-phase support in assisted reproductive cycles: A clinical trial study

Abstract

Background: The effect of adding gonadotropin-releasing hormone (GnRH) agonist on the luteal phase support in assisted reproductive technique (ART) cycles is controversial.
 Objective: To determine the effects of adding multiple doses of GnRH agonist to the routine luteal phase support on ART cycle outcomes.
 Materials and Methods: This clinical trial study included 200 participants who underwent the antagonist protocol at the Research and Clinical Center for Infertility, Yazd, Iran, between January and March 2020. Of the 200, 168 cases who met the inclusion criteria were equally divided into two groups – the case and the control groups. Both groups received progesterone in the luteal phase, following which the case group received GnRH agonist subcutaneously (0/1 mg triptorelin) zero, three, and six days after the fresh embryo transfer, while the control group did not receive anything. Finally, chemical and clinical pregnancy rates, number of mature oocytes, fertilization rate, total dose of gonadotropin, and the estradiol level were determined.
 Results: The baseline characteristics were similar in both groups. No significant difference was observed between embryo transfer cycles. Clinical results showed that differences between the fertilization rate, chemical and clinical pregnancies were not significant.
 Conclusion: The results showed that receiving multiple doses of GnRH agonist in the luteal phase of ART cycles neither improves embryo implantation nor the pregnancy rates; therefore, further studies are required.
 Key words: Luteal phase, GnRH agonist, ART, Pregnancy rate.

Single-Dose Versus Multiple-Dose GnRH Agonist for Luteal-Phase Support in Women Undergoing IVF/ICSI Cycles: A Network Meta-Analysis of Randomized Controlled Trials

“…Among them, 24 studies were retrieved for full-text evaluation after excluding 396 ineligible studies. Then, 9 unique studies ( 18 , 19 , 21 , 40 – 45 ) were considered to meet selection criteria after excluding 8 ineligible studies due to conference abstract without sufficient data and ineligible topic. Additional 7 eligible studies ( 13 , 22 , 23 , 46 , 47 ) were retrieved from previous meta-analysis and reference lists, and then we included 16 eligible studies ( 13 , 18 , 19 , 21 – 23 , 40 – 49 ) in this network meta-analysis.…”

“…Among 16 eligible studies, majority of studies were published in Turkey ( 18 , 40 – 42 ) and Iran ( 21 , 43 – 45 ), and remaining studies were published in Spain ( 49 ), Denmark ( 48 ), Japan ( 13 ), India ( 22 ), Belgium ( 46 ), Jordan ( 47 ), and China ( 19 ), respectively. Eight studies ( 40 – 45 , 48 , 49 ) compared single-dose versus controls, six studies ( 13 , 21 – 23 , 46 , 47 ) compared multiple-dose versus controls, one study ( 19 ) compared single-dose versus multiple-dose, and one study ( 18 ) simultaneously single-dose, multiple-dose, and control regime. Table 1 shown the basic characteristics of each study, and Figure 2 displayed the evidence network of each outcome.…”

“…Figures S1 displayed the results of the Cochrane risk of bias assessment for 16 eligible studies. Only one study ( 21 ) was classified as high risk owing to inadequate random sequence generation and allocation concealment. Two studies ( 19 , 42 ) were classified as high risk because they did not use the correct blinding method.…”

“…Regarding other bias, two studies ( 40 ) were rated having a high risk of bias. Briefly, approximately 13.75% of the studies ( 18 , 19 , 21 , 40 , 42 , 45 , 46 ) were classified as high risk of overall bias.…”

“…However, in addition to single-dose administration, multiple-dose protocol of GnRH agonist as a LPS protocol has become more and more common ( 16 ). Up to now, the paucity of studies directly compared single-dose versus multiple-dose GnRH agonist protocol ( 18 – 20 ) although there were relatively numerous studies directly comparing single-dose ( 16 ) or multiple-dose ( 21 – 23 ) protocol with control protocols, respectively. As a result, optimal administration strategy of GnRH agonist remains debated.…”