GnRH agonist plus vaginal progesterone for luteal phase support in ICSI cycles: a randomized study

Abstract

He continues to supervise post-graduate degrees in Obstetrics and Gynecology and related subjects. He is also Clinical Director at the Egyptian IVF-ET Centre, Maadi, Cairo, Editor-in-Chief of the Middle East Fertility Society Journal and a regular reviewer for several international journals. He has organized scientific meetings in Egypt in collaboration with key European and American centres, and participated in many international meetings.

GnRH agonist during luteal phase in women undergoing assisted reproductive techniques: systematic review and meta-analysis of randomized controlled trials

“…Figure summarizes the study inclusion process. Ten studies from 12 records were included in this review: two studies with two records each and eight studies with one record each. At the time of writing, of the potentially eligible records/studies, five studies (from five records) were awaiting classification and were not included; four of these are ongoing studies and one has unknown status.…”

“…For the probability of live birth or ongoing pregnancy (Figure 2), evidence from eight studies examining 2776 women showed a relative risk (RR) of 1.26 (95% CI, 1.04-1.53; I 2 = 58%). Sensitivity analysis, excluding the studies that did not report live birth and those at high risk of bias, resulted in one study examining 181 women with an RR of 1.07 19 Ata (2008) 16 Inamdar (2012) 20 Isikoglu (2007) 17 Qublan (2008) 22 Tesarik (2006) 24 Yildiz (2014) (95% CI, 0.73-1.58). Subgroup analysis according to agonist and antagonist cycles was unable to explain the observed heterogeneity; however, the studies that did not observe any benefit of using GnRH agonist during the luteal phase were those that used an agonist protocol for COS, while the two studies that used a GnRH antagonist for the intervention protocol observed more ongoing pregnancies in the intervention group ( Figure S1).…”

“…Second, the quality was downgraded one level due to imprecision: although there are a relatively large number of participants and events, the 95% CI of the RR and of the NNTB are wide (Table 1), not being sufficiently precise to ascertain whether the benefit would be clinically irrelevant or large. The third reason for downgrading was the unexplainable inconsistency across studies: some larger 0.1 82 122 78 30 44 22 23 141 79 12 224 285 213 74 90 60 90 300 184 50 72 120 75 16 45 8 9 113 30 4 222 285 213 80 91 60 90 300 95 19 Ata (2008) 16 Inamdar (2012) 20 Isikoglu (2007) 17 Isik (2009) 21 Qublan (2008) 22 Razieh (2009) 23 Tesarik (2006) 24 Yildiz (2014) 25 Zafardoust (2015) 26 Total (95% CI) Total events Heterogeneity: tau 2 = 0.04; chi 2 = 23.04, df = 9 (P = 0.006); I 2 = 61% Test for overall effect: Z = 2.89 (P = 0.004) 19 Ata (2008) 16 Inamdar (2012) 20 Isikoglu (2007) 17 Isik (2009) 21 Qublan (2008) 22 Tesarik (2006) 24 Yildiz (2014) 25 Total (95% CI) studies observed no effect while others observed a benefit of the intervention. Lastly, the quality was downgraded because of a strong suspicion of publication bias.…”

Impact of Mid-Luteal Phase GnRH Agonist Administration on Reproductive Outcomes in GnRH Agonist-Triggered Cycles: A Randomized Controlled Trial

“…However, only in GnRH antagonist cycles a significant increase in the OP was observed (16). Subsequent studies demonstrated that LP GnRHa supplementation seemed to benefit the GnRH antagonist co-treated cycle (8, 16, 25–27) more than the long GnRHa co-treated cycle (18, 19, 28). The main reason for this is the down-regulation of the pituitary, which is induced by the long GnRHa protocol (28).…”

“…Subsequent studies demonstrated that LP GnRHa supplementation seemed to benefit the GnRH antagonist co-treated cycle (8, 16, 25–27) more than the long GnRHa co-treated cycle (18, 19, 28). The main reason for this is the down-regulation of the pituitary, which is induced by the long GnRHa protocol (28). In support of this conclusion, Kung et al (29) recently verified that luteal GnRHa administration significantly increased clinical pregnancy and LB rates in GnRH antagonist co-treated patients, but not in patients undergoing a long GnRHa down-regulation protocol.…”