Does Gonadotropin-Releasing Hormone Agonist Administration Before Assisted Reproduction Techniques Improve Pregnancy Rates in Women With Endometriosis?

Panagodimou EK, Evangelia K Panagodimou, Evangelia Panagodimou, Kalogeropoulos S, Sotiris Kalogeropoulos, Georgios Adonakis, Adonakis G, Kaponis A, Apostolos Kaponis
Obstetrical & gynecological survey · 2024 · vol. 79(7) , pp. 421–428 · doi:10.1097/ogx.0000000000001283 · PMID:39026443 · W4400840492
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⚙ AI-generated summary by gemini-2.5-flash-lite, 2026-06-07 ⓘ

This review clarified that GnRH-agonist pretreatment may positively affect IVF pregnancy rates in severe endometriosis (stages III-IV) but is not routinely recommended.

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⚙ AI-generated deep summary by qwen3.7-flash, 2026-08-17 · read from full text ⓘ

This review evaluates whether administering gonadotropin-releasing hormone agonists prior to assisted reproduction techniques enhances clinical pregnancy rates in women with endometriosis. The authors analyzed data from two Cochrane meta-analyses and sixteen additional studies to assess the efficacy of this pretreatment strategy. They concluded that while GnRH agonists may benefit patients with severe disease, routine use is not recommended for improving overall pregnancy outcomes due to insufficient evidence. This paper is centrally about endometriosis — specifically examining medical interventions for infertility associated with the condition.

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Abstract

IMPORTANCE: Axial downregulation with a 3- to 6-month administration of gonadotropin-releasing hormone agonists (GnRH-a) prior to assisted reproduction techniques has been proposed in order to improve clinical pregnancy rates in women with endometriosis. Although reduced inflammation, improved oocyte quality, and restored endometrial receptivity have been postulated, further investigation of their actual benefit and mechanism of action is considered essential. In that direction, well-designed clinical trials regarding the role of GnRH-a in IVF are necessary. OBJECTIVE: The purpose of this review is to clarify whether GnRH-a administration prior to IVF-FET procedures improves pregnancy rates in women with endometriosis. EVIDENCE ACQUISITION: A literature review was conducted in MEDLINE (PubMed), Cochrane, and Google Scholar and concluded on September 10, 2022. RESULTS: Two Cochrane meta-analyses and 16 selected studies present various interesting data of assisted reproduction technique procedures on patients with endometriosis-related infertility with or without depot GnRH-a pretreatment. CONCLUSIONS: The regimen may have a positive clinical effect on cases of severe endometriosis (American Society for Reproductive Medicine stages III-IV), but their use is not routinely recommended in order to improve pregnancy rates. RELEVANCE: Endometriosis and infertility are closely related through various pathogenetic mechanisms. Endometriosis has been traditionally considered to negatively affect fundamental aspects of the in vitro fertilization-frozen embryo transfer procedure. Numerous interventions, both medical and surgical, have been proposed in order to improve IVF success rates, and the optimal management of these cases poses an ever pressing challenge.
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Objective

The purpose of this review is to clarify whether GnRH-a administration prior to IVF-FET procedures improves pregnancy rates in women with endometriosis. Evidence Acquisition A literature review was conducted in MEDLINE (PubMed), Cochrane, and Google Scholar and concluded on September 10, 2022.

Results

Two Cochrane meta-analyses and 16 selected studies present various interesting data of assisted reproduction technique procedures on patients with endometriosis-related infertility with or without depot GnRH-a pretreatment.

Conclusions

The regimen may have a positive clinical effect on cases of severe endometriosis (American Society for Reproductive Medicine stages III–IV), but their use is not routinely recommended in order to improve pregnancy rates. Relevance Endometriosis and infertility are closely related through various pathogenetic mechanisms. Endometriosis has been traditionally considered to negatively affect fundamental aspects of the in vitro fertilization–frozen embryo transfer procedure. Numerous interventions, both medical and surgical, have been proposed in order to improve IVF success rates, and the optimal management of these cases poses an ever pressing challenge. Target audience Obstetricians and gynecologists, family physicians Learning objectives After completing this activity, the learner will be better able to describe the relationship between endometriosis and infertility, including implication of assisted reproduction techniques; discuss the role of GnRH-a pretreatment in IVF-FET procedures, in terms of results and underlying mechanism of action; and explain limitations of existing data and the need for further research.

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Condition tags

endometriosisinfertility

MeSH descriptors

Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

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