Does prolonged pituitary down-regulation with gonadotropin-releasing hormone agonist improve the live-birth rate in in vitro fertilization treatment?

Jianzhi Ren, Aiguo Sha, Dongmei Han, Ping Li, Jie Geng, Chaihui Ma
In: Fertility and Sterility · 2014 · vol. 102(1) , pp. 75–81 · doi:10.1016/j.fertnstert.2014.03.030 · PMID:24746740 · W2091297961
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This study investigated whether prolonged pituitary down-regulation with a GnRH agonist enhances live-birth rates in IVF treatments.

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Abstract

ObjectiveTo evaluate the effects of a prolonged duration of gonadotropin-releasing hormone agonist (GnRH-a) in pituitary down-regulation for controlled ovarian hyperstimulation (COH) on the live-birth rate in nonendometriotic women undergoing in vitro fertilization and embryo transfer (IVF-ET).DesignRetrospective cohort study.SettingUniversity-affiliated hospital.Patient(s)Normogonadotropic women undergoing IVF.Intervention(s)Three hundred seventy-eight patients receiving a prolonged pituitary down-regulation with GnRH-a before ovarian stimulation and 422 patients receiving a GnRH-a long protocol.Main outcome measure(s)Live-birth rate per fresh ET.Result(s)In comparison with the long protocol, the prolonged down-regulation protocol required a higher total dose of gonadotropins. A lower serum luteinizing hormone (LH) level on the starting day of gonadotropin and the day of human chorionic gonadotropin (hCG) and a fewer number of oocytes and embryos were observed in the prolonged down-regulation protocol. However, the duration of stimulation and number of high-quality embryos were comparable between the two groups. A statistically significantly higher implantation rate (50.27% vs. 39.69%), clinical pregnancy rate (64.02% vs. 56.87%) and live-birth rate per fresh transfer cycle (55.56% vs. 45.73%) were observed in the prolonged protocol.Conclusion(s)Prolonged down-regulation in a GnRH-a protocol might increase the live-birth rates in normogonadotropic women.

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