Effect of gonadotropin releasing hormon agonist addition to routine luteal phase support in intracytoplasmic sperm injection-embryo transfer cycles on pregnancy rates and outcomes

Year 2020, Volume: 17 Issue: 3, 440 - 445, 30.09.2020

Nagihan Cengaver , Tuba Memur , Mahmut Kuntay Kokanalı , Gülnur Özakşit , Nafiye Yılmaz

https://doi.org/10.38136/jgon.733835

Abstract

Amaç: GnRH-a uzun protokol ve GnRH-anta protokol ICSI-ET sikluslarında rutin Luteal Faz Desteği ((LFD)’ne GnRH-a eklenmesinin gebelik oranlarına ve sonuçlarına etkisini araştırmak
Gereçler ve Yöntem: Bu prospektif randomize çalışmaya ICSI-ET ile tedavi edilen yüz sekiz infertil çift dahil edildi. Hastalar iki farklı ovulasyon indüksiyon protokolüne tabi tutulmak için rastgele olarak iki gruba ayrıldı. Grup I'e GnRH-a uzun protokolü ve grup II'ye GnRH-anta protokolü uygulandı. İki protokol ile tedavi edilecek kadınlar da iki alt gruptan birine rastgele olarak ayrıldı. Ib ve IIb alt gruplarına, rutin LFD'ye [90 mg / gün vajinal progesteron artı 4 mg 17β Estradiol] ek olarak ET'den sonra 5. ve 10. günlerde löprolid asetat (0.5 mg s.c.) enjeksiyonları uygulandı. Diğer iki alt gruba (grup la ve IIa) ise sadece rutin LPD verildi.
Bulgular: Toplanan toplam oosit ve MII oosit sayısı, grup Ia'da grup Ib'den anlamlı olarak daha yüksekti. Grup I ve II'de alt gruplar arasında klinik gebelik, yumurtalık hiperstimülasyon sendromu (OHSS), çoğul gebelik, kürtaj, devam eden gebelik ve canlı doğum oranları açısından fark yoktu.
Sonuç: GnRH-a uzun protokol ve GnRH-anta protokol ICSI-ET sikluslarında GnRH-a'nın rutin LPD'ye eklenmesinin devam eden gebelik, kürtaj, çoğul gebelik, OHSS, klinik gebelik ve canlı doğum oranları üzerinde hiçbir etkisi olmadığı görülmektedir.

Keywords

gonadotropin, infertilite, luteal faz

Effect of gonadotropin releasing hormon agonist addition to routine luteal phase support in intracytoplasmic sperm injection-embryo transfer cycles on pregnancy rates and outcomes

Abstract

Abstract:
Aim: To investigate the effect of gonadotrophin releasing hormone agonist (GnRH-a) addition to luteal phase support (LPS) in intracytoplasmic sperm injection-embryo transfer (ICSI-ET) cycles of GnRH-a long protocol and GnRH antagonist (GnRH-anta) protocol, on pregnancy rates and outcomes.
Materials and Method: One hundred and eight infertile couples treated with ICSI-ET were included in this prospective randomized study. Patients were randomly divided into two groups to undergo two different ovarian stimulation protocols. GnRH-a iong protocol was applied to group I and GnRH-anta protocol was applied to group II. Women to be treated by each of the two protocols were also randomly assigned to one of the two subgroups. Subgroups Ib and IIb received leuprolide acetate (0.5 mg s.c.) injections on the 5th and 10th days after ET in addition to routine LPS [90 mg/day of vaginal progesterone plus 4 mg of 17β Estradiol]. Only routine LPS was given to other two subgroups (groups la and IIa).
Results: The total number of retrieved oocytes and MII oocytes were significantly higher in group Ia than in group Ib. There were no differences between subgroups in groups I and II regarding clinical pregnancy, ovarian hyperstimulation syndrome (OHSS), multiple pregnancy, abortion, ongoing pregnancy and live birth rates.
Conclusion: Addition of GnRH-a to routine LPS in ICSI-ET cycles of GnRH-a long protocol and GnRH-anta protocol seems to have no effect on ongoing pregnancy, abortion, multiple pregnancy, OHSS, clinical pregnancy and live birth rates.

Keywords

gonadotropin, infertility, luteal phase

References

• van der Linden M, Buckingham K, Farquhar C, Kremer JA, Metwally M. Luteal phasesupport for assisted reproduction cycles.Cochrane Database Syst Rev. 2011 Oct 5;(10):CD009154.
• Fatemi HM, Popovic-Todorovic B, Papanikolaou E, Donoso P, Devroey P. An update of luteal phasesupport in stimulated IVF cycles. Hum Reprod Update. 2007 Nov-Dec;13(6):581-90
• Shivapathasundram G, Kwik M, Chapman M. Luteal phase defect: part of the infertility zeitgeist or relic from the past?Hum Fertil (Camb). 2011 Mar;14(1):60-3.
• Fatemi HM. The luteal phase after 3 decades of IVF: what do we know? Reprod Biomed Online. 2009;19 Suppl 4:4331
• Devoto L, Kohen P, Muñoz A, Strauss JF 3rd. Human corpus luteum physiology and the luteal-phase dysfunction associated with ovarian stimulation.Reprod Biomed Online. 2009;18 Suppl 2:19-24. Review.
• Nardo LG, Sallam HN. Progesterone supplementation to prevent recurrent miscarriage and to reduce implantation failure in assisted reproduction cycles.Reprod Biomed Online. 2006 Jul;13(1):47-57. Review.
• Fatemi HM, Kolibianakis EM, Camus M, Tournaye H, Donoso P, Papanikolaou E et al. Addition of estradiol to progesterone for luteal supplementation in patients stimulated with GnRH antagonist/rFSH for IVF: a randomized controlled trial. Hum Reprod 2006;21:2628-32.
• Ubaldi F, Rienzi L, Ferrero S, Anniballo R, Iacobelli M, Cobellis L, et al. Low dose prednisolone administration in routine ICSI patients does not improve pregnancy and implantation rates. Hum Reprod 2002; 17: 1544- 7.
• Revelli A, Dolfin E, Gennarelli G, Lantieri T, Massobrio M, Holte JG, et al. Low-dose acetyl salicylic acid plus prednisolone as an adjuvant treatment in IVF: a prospective, randomized study. Fertil Steril 2008;90:1685-91.
• El-Toukhy T, Sunkara SK, Khairy M, Dyer R, Khalaf Y, Coomarasamy A. A systematic review and metaanalysis of acupuncture in in vitro fertilisation. BJOG 2008; 115: 1203-13.
• 1Tesarik J, Hazout A, Mendoza-Tesarik R, Mendoza N, Mendoza C. Beneficial effect of luteal phase GnRH agonist administration on embryo implantation after ICSI in both GnRH agonist and antagonist treated ovarian stimulation cycles. Hum Reprod 2006;21:2572-79.
• Pirard C, Donnez J, Loumaye E. GnRH agonist as luteal support in assisted reproduction technique cycles: results of a pilot study. Hum Reprod 2006;21:1894-1900.
• Tesarik J, Hazout A, Mendoza C. Enhancement of embryo developmental potential by a single administration of GnRH agonist at the time of implantation. Human Reprod 2004; 19: 1176 – 1180.
• Qublah H, Amarin Z, Al-Quda M, Diab F, Nawareh M, Malkawi S, et al. Luteal phase support with GnRH-a improves implantation and pregnancy rates in IVF cycles with endometrium of ≤7 mm on day of egg retrieval. Human Fertility, 2008; 11: 43 – 47.
• Razieh DF, Maryam AR, Nasim T. Beneficial effect of luteal-phase gonadotropin-releasing hormone agonist administration on implantation rate after intracytoplasmic sperm injection. Taiwan J Obstet Gynecol, 2009; 48:245-8.
• Isik AZ, Caglar GS, Sozen E, Akarsu C, Tuncay G, Ozbicer T, et al. Single-dose GnRH agonist administration in the luteal phase of GnRH antagonist cycles: a prospective randomized study. Reprod Biomed Online. 2009;19:472-7.
• Inamdar DB, Majumdar A Evaluation of the impact of gonadotropin-releasing hormone agonist as an adjuvant in luteal-phase support on IVF outcome. J Hum Reprod Sci. 2012 Sep;5(3):279-84. doi: 10.4103/0974-1208.106341.
• Akif Cam M, Kuran M. Effects of a single injection of hCG or GnRH agonist on day 12 post mating on fetal growth and reproductive performance of sheep. Anim Reprod Sci 2004; 80: 81–90.
• Ata B, Yakin K, Balaban B, Urman B. GnRH agonist protocol administration in the luteal phase in ICSI-ETcycles stimulated with the longGnRHagonist protocol: a randomized, controlled double blind study. Hum Reprod 2008; 23:668–73.
• Park WI, Kim SS, Chung HR, Shin SY, Lee JY. Early and late hormonal responses to the microdose gonadotropin-releasing hormone agonist in normal menstruating women. Fertil Steril 2004;81:1067-72.
• Vlahos NF, Lipari CW, Bankowski B, Lai TH, King JA, Shih IeM, et al. Effect of luteal-phase support on endometrial L-selectin ligand expression after recombinant follicle-stimulating hormone and ganirelix acetate for in vitro fertilization. J.Clin Endocrinol Metab 2006;91:4043-9.
• Siler-Khodr TM, Smikle CB, Sorem KA, Grayson MA, Spencer DK, Yoder BA, et al. Effect of excessive GnRH-binding substance on circulating maternal hCG in human pregnancy. Early Pregnancy 1997;3:10-4.
• Iwashita M, Kudo Y, Shinozaki Y, Takeda Y. Gonadotropin-releasing hormone increases serum human chorionic gonadotropin in pregnant women. Endocr J 1993;40:539-44.