Ultra-Long GnRH Agonist Protocol During IVF/ICSI Improves Pregnancy Outcomes in Women With Adenomyosis: A Retrospective Cohort Study

Lan, Jie; Wu, Yaoqiu; Wu, Zexuan; Wu, Yingchen; Rong, Yang; Liu, Ying; Lin, Haifan; Jiao, Xuedan; Zhang, Qingxue

doi:10.3389/fendo.2021.609771

Cited by 28 publications

(23 citation statements)

References 46 publications

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“…GnRH modulators may improve reproductive outcomes among women with adenomyosis undergoing IVF. In a large retrospective cohort, pretreatment with an ultra-long GnRH-agonist (2–4 months prior to embryo transfer) compared with a long GnRH-agonist (single dose given in the preceding cycle luteal phase prior to ovarian stimulation) improved the live birth rate, 43 vs. 26%, P = 0.019, and clinical pregnancy rate, 55 vs. 38%, P = 0.025 [31 ▪ ]. In a similar retrospective cohort, an ultra-long GnRH agonist protocol compared with a long agonist protocol was also associated with increased live birth rate and clinical pregnancy rate with fresh transfer [32 ▪ ].…”

Section: Treatment Of Adenomyosis For Patients With Infertilitymentioning

confidence: 99%

Adenomyosis and fertility: does adenomyosis impact fertility and does treatment improve outcomes

French

Zhang

Movilla

et al. 2022

Current Opinion in Obstetrics &Amp; Gynecology

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Purpose of reviewAdenomyosis has recently been associated with infertility. Relief of bleeding and pain has been demonstrated with medical and surgical therapy. Less is known about reproductive outcomes after treatment. Recent findingsImaging findings during infertility evaluation can be suggestive of adenomyosis without pathologic evaluation. Among women with infertility undergoing assisted reproductive technologies (ART), adenomyosis is associated with lower live birth rates and clinical pregnancy rates. Treatment with gonadotropin releasing hormone (GnRH) modulators prior to frozen embryo transfer may increase the live birth rate and clinical pregnancy rate among women with adenomyosis. Pregnancy has been documented following image-guided adenomyosis ablation; however, the reproductive impact is not well established. Pregnancy following excisional procedures appears to be well tolerated, although may carry a higher risk of uterine rupture compared with pregnancy following myomectomy. It is not clear if ablative therapy or resection increases pregnancy rates. SummaryAdenomyosis is associated with lower embryo implantation rates and ongoing pregnancy rates. Adenomyotic changes in the uterus can be seen by ultrasound and MRI. GnRH modulators may be useful for women with adenomyosis undergoing ART. Additional prospective data is warranted to determine the optimal medical or surgical therapy for women with adenomyosis desiring conception.

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Section: Treatment Of Adenomyosis For Patients With Infertilitymentioning

confidence: 99%

Adenomyosis and fertility: does adenomyosis impact fertility and does treatment improve outcomes

French

Zhang

Movilla

et al. 2022

Current Opinion in Obstetrics &Amp; Gynecology

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“…Two studies concluded that conservative surgery combined with GnRH agonist, rather than GnRH agonist alone, is able to improve symptoms and boost reproductive potential in adenomyosis patients [ 90 , 91 ]. Finally, an ultra-long GnRH protocol before ovarian stimulation appears to yield better pregnancy outcomes than the corresponding long protocol [ 92 , 93 ]. More specifically, one study reported significantly higher pregnancy and live birth rates in patients with diffuse adenomyosis receiving a 3.75 mg dose of diphereline subcutaneously on a monthly basis for 2–4 months prior to stimulation compared to corresponding patients receiving a single 0.93–1.87 mg dose on the 18th–20th day [ 92 ].…”

Section: Medical Treatment Of Adenomyosismentioning

confidence: 99%

“…Finally, an ultra-long GnRH protocol before ovarian stimulation appears to yield better pregnancy outcomes than the corresponding long protocol [ 92 , 93 ]. More specifically, one study reported significantly higher pregnancy and live birth rates in patients with diffuse adenomyosis receiving a 3.75 mg dose of diphereline subcutaneously on a monthly basis for 2–4 months prior to stimulation compared to corresponding patients receiving a single 0.93–1.87 mg dose on the 18th–20th day [ 92 ]. Consistent with these findings, a second study reported a significant increase in rates of both clinical pregnancy and live births in adenomyosis patients pre-treated with triptorelin (3.75 mg) intramuscularly every 28 days for at least 3 months, compared with 0.1 mg/day dose for 10 days [ 93 ].…”

Section: Medical Treatment Of Adenomyosismentioning

confidence: 99%

Conservative Management of Uterine Adenomyosis: Medical vs. Surgical Approach

Stratopoulou

Donnez

Dolmans

2021

JCM

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Uterine adenomyosis is a commonly encountered estrogen-dependent disease in reproductive-age women, causing heavy menstrual bleeding, intense pelvic pain, and infertility. Although adenomyosis was previously considered a disease of multiparous women, it is becoming increasingly evident that it also affects younger nulliparous women and may compromise their fertility potential. It is clear that hysterectomy, the standard approach to definitively manage the disease, is not an option for patients wishing to preserve their fertility, so there is an urgent need to develop novel conservative strategies. We searched the current literature for available methods for conservative management of adenomyosis, including both pharmacological and surgical approaches. There is no existing drug that can cure adenomyosis at present, but some off-label treatment options may be used to tackle disease symptoms and improve fertility outcomes. Adenomyosis in patients wishing to conceive can be ‘treated’ by conservative surgery, though these procedures require highly experienced surgeons and pose a considerable risk of uterine rupture during subsequent pregnancies. While currently available options for conservative management of adenomyosis do have some capacity for alleviating symptoms and enhancing patient fertility perspectives, more effective new options are needed, with gonadotropin-releasing hormone antagonists showing encouraging results in preliminary studies.

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“…It was noted that an essential part of full-dose GnRH-a is involved in the improvement of follicular synchronization and endometrial receptivity. As a consequence, this prolonged downregulation before controlled ovarian hyperstimulation (COH) and embryo transfer (ET) might be acceptable in patients with endometriosis [9], adenomyosis [10,11], and a general cohort [12,13]. However, several studies have been performed to compare outcomes between the depot GnRH-a protocol and long protocol, with different conclusions presented regarding Gn doses, the duration of stimulation, the number of retrieved oocytes, fertilization rates, and pregnancy rates [1,6,[13][14][15][16][17][18][19].…”

Section: Introductionmentioning

confidence: 99%

The follicular-phase depot GnRH agonist protocol results in a higher live birth rate without discernible differences in luteal function and child health versus the daily mid-luteal GnRH agonist protocol: a single-centre, retrospective, propensity score matched cohort study

Zhang

Zhao

Han

et al. 2022

Reprod Biol Endocrinol

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Background The gonadotropin-releasing hormone agonist (GnRH-a) has been used in in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycles for a long time. This paper evaluates the efficacy and safety of two commonly used protocols (follicular-phase depot GnRH-a protocol and daily mid-luteal long GnRH-a protocol) in normal responders undergoing IVF/ICSI using propensity score matching (PSM) analysis. Methods A total of 6,816 infertile women treated within the period from January 2016 to September 2020 were stratified into cohorts. A total of 2,851 patients received the long-acting group (depot GnRH-a protocol), and 1,193 used the short-acting group (long GnRH-a protocol) after the data-selection process. PSM was utilized for sampling by up to 1:1 nearest neighbour matching to adjust the numerical difference and balance the confounders between groups. The primary outcome was the live birth rate (LBR). Multivariable logistic analysis was used to evaluate the difference between these two protocols in relation to the LBR. Result(s) In this study, 1:1 propensity score matching was performed to create a perfect match of 964 patients in each group. After matching, the blastocyst formation rates, oestradiol (E2) value on Day hCG + 9, progesterone (P) value on Day hCG + 9, implantation rates, clinical pregnancy rates, and LBR were more favourable in the depot GnRH-a protocol than in the long GnRH-a protocol (P < 0.05). However, the moderate or severe OHSS rates were higher in the depot group than in the long group (P < 0.001). There were no significant differences in endometrial thickness, luteal support medication, early pregnancy loss rates, mid- and late-term pregnancy loss rates, or foetal malformation rates between the two protocols. Conclusion(s) Compared with the daily short-acting GnRH agonist protocol, the follicular-phase depot GnRH-a protocol might improve LBRs in normogonadotropic women without discernible differences in luteal function and child health.

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Ultra-Long GnRH Agonist Protocol During IVF/ICSI Improves Pregnancy Outcomes in Women With Adenomyosis: A Retrospective Cohort Study

Cited by 28 publications

References 46 publications

Adenomyosis and fertility: does adenomyosis impact fertility and does treatment improve outcomes

Adenomyosis and fertility: does adenomyosis impact fertility and does treatment improve outcomes

Conservative Management of Uterine Adenomyosis: Medical vs. Surgical Approach

The follicular-phase depot GnRH agonist protocol results in a higher live birth rate without discernible differences in luteal function and child health versus the daily mid-luteal GnRH agonist protocol: a single-centre, retrospective, propensity score matched cohort study

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