In a nutshell
This study compared the effectiveness and safety of single-dose (DS) versus multiple-dose (MD) GnRH agonist protocol for luteal phase support in patients undergoing in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) cycles. The data showed that the MD protocol was more effective in increasing the live birth and clinical pregnancy rate and single-dose protocol was more effective in increasing the multiple pregnancy rate in these patients.
In vitro fertilization (IVF) is a common infertility treatment that involves transferring embryo(s) into the uterus. To establish a pregnancy, the embryo needs to implant in the lining of the uterus (endometrium). It is necessary for the uterine lining to stay thick during the luteal phase. The luteal phase is the second half of the menstrual cycle when the embryo is implanting. However, it is common for IVF cycles to have luteal phase defects, in which there is not enough support for the lining of the uterus. During IVF, patients are routinely administered a hormone called progesterone, to improve the chances of the fertilized embryo becoming implanted in the endometrium.
Gonadotropin-releasing hormone (GnRH) is a chemical produced by the brain to stimulate the ovaries to release other hormones such as follicle-stimulating hormone (FSH). Recent studies have suggested that incorporating an GnRH agonist into the IVF strategy may improve implantation rates. However, it is not known whether a single dose or multiple doses of GnRH are necessary for luteal-phase support in patients undergoing IVF/ICSI cycles.
Methods & findings
This study analyzed 16 other studies involving infertile patients undergoing IVF/ICSI cycles. Patients received either SD or MD GnRh agonist treatment.
MD protocol of GnRH agonist increased the live birth rate (by 1.80 times), clinical pregnancy rate (by 1.89 times), and decreased the miscarriage rate (by 0.55 times) compared to a control protocol.
SD protocol of GnRH agonist increased the clinical pregnancy rate (by 1.45 times) and multiple pregnancy rate (by 2.55 times) compared to a control protocol.
Overall, the MD protocol of GnRH agnonist improved the rate of live birth rate by 54%, the clinical pregnancy rate by 49%, and the multiple pregnancy rate by 31% compared to the SD protocol of GnRH agonist.
The bottom line
This study concluded that multiple-dose protocol GnRH agonist was more effective in increasing the live birth and clinical pregnancy rate compared to SD protocol of GnRH agonist in patients undergoing IVF/ICSI cycles.
The fine print
The number of studies analyzed was very small. Different doses and drugs of GnRH agonist protocols were used in different studies. More studies are needed to confirm the findings.
Published By :
Frontiers in Endocrinology
Apr 19, 2022