STROBE-GnRHa pretreatment in frozen-embryo transfer cycles improves clinical outcomes for patients with persistent thin endometrium: A case-control study

Abstract

The well-prepared endometrium with appropriate thickness plays a critical role in successful embryo implantation. The thin endometrium is the main factor of frozen-embryo transfer (FET), resulting in the failure of implantation undergoing FET. Hormone treatment is suggested to improve endometrium thickness; however, among the larger numbers of cases, it cannot reach the sufficient thickness, which leads to a high cancelation rate of embryo transfer as well as waste high-quality embryos. Thus, it increases the burden to patients in both economic and psychological perspectives. We performed a retrospective observational study, which was composed with 2 cohorts, either with the conventional hormone replacement therapy (HRT) protocol or HRT with gonadotrophin-releasing hormone agonist (GnRHa) pretreatment to prepare the endometrium before FET. The measurements of endometrium thickness, hormone level, transfer cycle cancelation rate, pregnancy rate, and implantation rate were retrieved from the medical records during the routine clinic visits until 1 month after embryo transfer. The comparisons between 2 cohorts were performed by t-test or Mann-Whitney U test depending on the different attributions of data. In total, 49 cycles were under HRT with GnRHa pretreatment and 84 cycles were under the conventional HRT protocol. HRT with GnRHa pretreatment group improved the endometrial thickness (8.13 ± 1.79 vs 7.51 ± 1.45, P = .031), decreased the transfer cancelation rate (P = .003), and increased clinical pregnancy rate and implantation rate significantly (both P = .001). Additionally, luteinizing hormone level in pretreatment group was consistently lower than conventional HRT group (P < .05). Our study revealed HRT with GnRHa pretreatment efficiently improved the endometrial thickness, therefore, decreased the FET cycle cancelation. It also elevated the embryo implantation rate and clinical pregnancy rate by improving endometrial receptivity.Abbreviations: AdjOR = adjusted odds ratio, BMI = body mass index, E2 = estradiol, Em = increased endometrial thickness, FET = frozen-embryo transfer, FSH = follicle stimulating hormone, GnRHa = gonadotrophin-releasing hormone agonist, hCG = human chorionic gonadotrophin, HRT = hormone replacement therapy, LH = luteinizing hormone, ROC = receiver operating characteristic, SD = standard deviation.

Effect of Elevated Progesterone Levels on hCG Trigger Day on Clinical Pregnancy Outcome in Short-Acting GnRHa Downregulated Cycles

“…Previous studies suggested that the pre-treatment of long-acting GnRHa was conducive to the establishment of endometrial receptivity, and the endometrial receptivity of long-acting GnRHa IVF cycle is better than that of short-acting GnRHa IVF cycle. 27,28 We speculate that this may be the possible reason for the different predicted P cut-off values of these two COH protocols. Cleavage-stage embryos transfer has certain advantages in short-acting GnRHa IVF-ET cycles.…”

New advances in the treatment of thin endometrium

“…GnRH-a drugs are the first-line of clinical use in assisted reproduction and endometriosis. After the first application of GnRH-a, it binds to the GnRH receptor in the pituitary gland and instantly stimulates the release of gonadotropins (follicle stimulating hormone and luteinizing hormone) from pituitary cells, resulting in a ‘flare-up’ effect, which raises the serum estrogen level and stimulates the body to produce the cytokines necessary for implantation, thus improving the EMT and increasing endometrial tolerance ( 31 ). GnRH-a in combination with human menopausal gonadotropin also enhances the stimulation of follicular development and improves EMT in women undergoing FET after intensified estrogen administration ( 32 ).…”

The effect of gonadotropin-releasing hormone agonist downregulation in conjunction with hormone replacement therapy on endometrial preparation in patients for frozen–thawed embryo transfer

“…For the different endometrial preparation protocols commonly used, studies have shown that there is no significant difference in the HRT cycle or GnRHa-HRT cycle and the latter protocol increases the cost of treatment ( 12 , 13 ). On the contrary, studies have also shown that GnRHa-HRT effectively improved clinical pregnancy ( 14 ) and live birth rates ( 15 ). Based on the results of the above studies, some controversies about the advantages and disadvantages of the HRT cycle or GnRHa-HRT cycle in endometrial preparation protocols still exist.…”