Artificial Cycle with or without a Depot Gonadotropin-releasing Hormone Agonist for Frozen-thawed Embryo Transfer: An Assessment of Infertility Type that Is Most Suitable

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This study compared frozen-thawed embryo transfer outcomes with and without a GnRH agonist, finding higher live birth rates and improved outcomes, particularly for PCOS patients, when the agonist was used.

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This retrospective cohort study evaluated whether adding a depot gonadotropin-releasing hormone (GnRH) agonist to an artificial endometrial preparation regimen (exogenous estrogen plus progesterone) improves outcomes of frozen-thawed cleavage-stage embryo transfers. Across 1003 cycles (2012–2015) at a single center, infertility patients were categorized by etiology (tubal, PCOS, endometriosis, male, unexplained), and live birth rate was the primary outcome; the paper reports that baseline hormone levels and characteristics were similar between treatment (GnRH agonist cotreatment) and control (estrogen/progesterone only) groups, with ectopic pregnancy rate lower in the GnRH agonist group. Live birth rates were higher with GnRH agonist cotreatment overall (41.67% vs 29.29%), and other pregnancy-related metrics followed similar trends, particularly in women with PCOS; a key limitation is the retrospective, single-center design. Relevance to endometriosis: endometriosis is included as one of the infertility types analyzed in this embryo-transfer cohort, though the results highlighted by the paper focus especially on overall effects and PCOS.

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Abstract

The clinical outcomes of five groups of infertility patients receiving frozen-thawed, cleavage-stage embryo transfers with exogenous hormone protocols with or without a depot gonadotropin-releasing hormone (GnRH) agonist were assessed. A retrospective cohort analysis was performed on 1003 cycles undergoing frozen-thawed, cleavage-stage embryo transfers from January 1, 2012 to June 31, 2015 in the Reproductive Medicine Center of Wuhan General Hospital of Guangzhou Military Region. Based on the infertility etiologies of the patients, the 1003 cycles were divided into five groups: tubal infertility, polycystic ovary syndrome (PCOS), endometriosis, male infertility, and unexplained infertility. The main outcome was the live birth rate. Two groups were set up based on the intervention: group A was given a GnRH agonist with exogenous estrogen and progesterone, and group B (control group) was given exogenous estrogen and progesterone only. The results showed that the baseline serum hormone levels and basic characteristics of the patients were not significantly different between groups A and B. The live birth rates in groups A and B were 41.67% and 29.29%, respectively (P<0.05). The live birth rates in patients with PCOS in groups A and B were 56.25% and 30.61%,respectively (P<0.05). The clinical pregnancy, implantation and on-going pregnancy rates showed the same trends as the live birth rates between groups A and B. The ectopic pregnancy rate was significantly lower in group A than in group B. We concluded that the live birth rate was higher and other clinical outcomes were more satisfactory with GnRH agonist cotreatment than without GnRH agonist co-treatment for frozen-thawed embryo transfer. The GnRH agonist combined with exogenous estrogen and progesterone worked for all types of infertility tested, especially for women with PCOS.
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Summary The clinical outcomes of five groups of infertility patients receiving frozen-thawed, cleavage-stage embryo transfers with exogenous hormone protocols with or without a depot gonadotropin-releasing hormone (GnRH) agonist were assessed. A retrospective cohort analysis was performed on 1003 cycles undergoing frozen-thawed, cleavage-stage embryo transfers from January 1, 2012 to June 31, 2015 in the Reproductive Medicine Center of Wuhan General Hospital of Guangzhou Military Region. Based on the infertility etiologies of the patients, the 1003 cycles were divided into five groups: tubal infertility, polycystic ovary syndrome (PCOS), endometriosis, male infertility, and unexplained infertility. The main outcome was the live birth rate. Two groups were set up based on the intervention: group A was given a GnRH agonist with exogenous estrogen and progesterone, and group B (control group) was given exogenous estrogen and progesterone only. The results showed that the baseline serum hormone levels and basic characteristics of the patients were not significantly different between groups A and B. The live birth rates in groups A and B were 41.67% and 29.29%, respectively (P<0.05). The live birth rates in patients with PCOS in groups A and B were 56.25% and 30.61%,respectively (P<0.05). The clinical pregnancy, implantation and on-going pregnancy rates showed the same trends as the live birth rates between groups A and B. The ectopic pregnancy rate was significantly lower in group A than in group B. We concluded that the live birth rate was higher and other clinical outcomes were more satisfactory with GnRH agonist cotreatment than without GnRH agonist co-treatment for frozen-thawed embryo transfer. The GnRH agonist combined with exogenous estrogen and progesterone worked for all types of infertility tested, especially for women with PCOS. Similar content being viewed by others References Roque M, Lattes ?, Serra S, et al. 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Artificial Cycle with or without a Depot Gonadotropin-releasing Hormone Agonist for Frozen-thawed Embryo Transfer: An Assessment of Infertility Type that Is Most Suitable. CURR MED SCI 38, 626–631 (2018). https://doi.org/10.1007/s11596-018-1923-0 Received: Revised: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s11596-018-1923-0

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endometriosisinfertility

MeSH descriptors

Embryo Culture Techniques Embryo Transfer Fertility Agents, Female Gonadotropin-Releasing Hormone Infertility Leuprolide Adult Cryopreservation Cryopreservation Embryo Culture Techniques Embryo Transfer Embryo Transfer Estrogens Estrogens Female Fertility Agents, Female Fertility Agents, Female Fertility Agents, Female Gonadotropin-Releasing Hormone Gonadotropin-Releasing Hormone

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