Gonadotropin-releasing hormone analogue as sole luteal support in antagonist-based assisted reproductive technology cycles

In in vitro fertilization antagonist-based cycles, gonadotropin- releasing hormone analogues provide good luteal support and more live birth rates, and alleviate the need for inconvenient conventional P supplementation.

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Volume 107, Issue 1, Pages 130-135

Authors:

Itai Bar Hava, M.D., Moran Blueshtein, Ph.D., Hadas Ganer Herman, M.D., Yeela Omer, M.D., Gila Ben David, M.D.

Abstract:

Objective

To evaluate the efficacy of GnRH agonists (GnRH-a) as sole luteal phase support in patients undergoing IVF in antagonist-based cycles compared with standard vaginal P preparations.

Design

Retrospective cohort.

Setting

Private fertility clinic.

Patient(s)

Patients who underwent antagonist-based cycles performed at our clinic between 2009 and 2015.

Intervention(s)

Intranasal GnRH-a or vaginal P as luteal support.

Main Outcome Measure(s)

Live birth rates.

Result(s)

A total of 2,529 antagonist-based cycles from 1,479 women were available for analysis, in which GnRH-a were used in 1,436 cycles (56.7%) and P supplementation in 1,093 cycles (43.2%). Significantly higher live birth rates were demonstrated for the entire GnRH-a group compared with the P group. This result was even more prominent when women older than 35 years were considered separately. Furthermore, after adjustment for age, body mass index (BMI), past obstetric history, number of IVF cycles, oocyte retrieved and embryos transferred, GnRH-a was still associated with a higher rate of live birth (odds ratio 1.46, 95% confidence interval 1.10–1.94). Once a positive β-hCG was achieved, chemical pregnancy rates (PRs) and miscarriage rates were not statistically different between the GnRH-a and the P supplementation group, and GnRH-a was associated with a higher rate of live births (odds ratio 1.59, 95% confidence interval 1.07–2.36).

Conclusion(s)

This large retrospective study suggests that repeated intranasal GnRH-a for luteal phase support is associated with a higher live birth rate compared with standard P supplementations.


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Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.

2 Comments

Go to the profile of Enrique Perez de la Blanca
Enrique Perez de la Blanca about 1 month ago

Congratulations for your study. It is very interesting and can have important consequences in luteal phase management if widely confirmed.

Although retrospective, its number of patients is high enough to deserve great attention and to use it as a reproducibility confirmation of Pirard et al´s findings in their small RCT, as well as with your group´s previous findings in high responders.

I would like to make a question:

Don´t you think that there are evidences enough to use it in every patients as you did in high responders, or Pirard´s group did in normoresponders, without HCG? Should we have any concern about that?

Thank you very much.

Go to the profile of Lee Gyeong Hun
Lee Gyeong Hun 17 days ago

pleased to read your wonderful journal. But I had some question with regard to P-supplementation depending on E2 and P4 in midluteal phase.

The journal told that the vaginal dosage was doubled in cases of low mid-luteal phase. but when and how did P4 supplementation change?

please let me get clear image of your P4 group.