Pregnancy outcome in long- versus short-acting gonadotropin-releasing hormone agonist cycles in participants with normal ovarian reserve: An RCT.

Kabodmehri R, Ghanami Gashti N, Raoufi A, Marzieh Mehrafza, Nikpouri Z, Hosseinzadeh E, Hosseini A
International journal of reproductive biomedicine · 2023 · doi:10.18502/ijrm.v21i9.14402 · PMID:37969567 · PMC10643683
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This randomized controlled trial compared reduced-dose long-acting versus short-acting gonadotropin-releasing hormone agonist protocols in 400 women undergoing intracytoplasmic sperm injection for infertility. The study found no significant differences between the two groups regarding clinical pregnancy rates, implantation rates, or embryo quality, although the long-acting protocol resulted in a significantly lower incidence of ovarian hyperstimulation syndrome and fewer cycle cancellations. A major limitation noted was that participants with moderate to severe endometriosis were explicitly excluded from enrollment to ensure a cohort with normal ovarian reserve. Relevance to endometriosis: listed as an exclusion criterion, though the paper's main focus is uterine fibroids.

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Abstract

BackgroundThere is no agreement on which of the 2 gonadotropin-releasing hormone (GnRH) agonist protocols are the most efficient, neither there is any consensus on which one yields a better clinical pregnancy percentage.ObjectiveThe present study aims to compare the effectiveness of reduced dosages of long- and short-acting GnRH agonists on pregnancy outcomes.Materials and methodsIn this randomized controlled clinical trial, 400 women were randomly assigned to 2 groups (n = 200/group): the reduced dosage of long-acting GnRH agonist group (group 1, 1.25 mg Decapeptyl) and the short-acting GnRH agonist group (group 2, 0.5 mg/day Buserelin Acetate). The study was conducted at Mehr Medical Institute, Rasht, Iran between July 2019 and July 2020. Biochemical and clinical pregnancy were compared between groups.ResultsNo significant differences were observed in the endometrial lining, the total number of retrieved and metaphase-II oocytes, progesterone, and serum estradiol levels on human chorionic gonadotropin day, fertilization rate, and top-quality embryos between the groups. The duration of induction (10.8 ± 1.7 vs. 10 ± 2.1, p < 0.001) and the total dosage of gonadotropins (2939.4 ± 945.9 vs. 2441 ± 1247.1, p < 0.001) were significantly greater in group 2 than in group 1. No significant differences were observed between the 2 groups in terms of implantation rate, chemical pregnancy rate, and clinical pregnancy rate. A higher percentage of ovarian hyperstimulation syndrome was observed in group 2 (p = 0.005).ConclusionDue to a lower percentage of ovarian hyperstimulation syndrome in group 1 and similar assisted reproductive technology outcomes in both groups, the long protocol was found to be superior to the short protocol.
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As discussed in the previous sections, the lower incidence of OHSS observed in group 1, coupled with comparable ART outcomes between the 2 groups, suggests that the long-acting depot protocol holds an advantage over the daily agonist protocol. This superiority is attributed to the greater comfort it offers to participants. The management of OHSS presents significant challenges, underscoring the importance of identifying improved ovarian stimulation methods to either prevent OHSS or mitigate its occurrence. Our study's findings, which demonstrated a reduction in the OHSS rate within the long-acting group, contribute valuable insights to the ongoing research in this area. By highlighting the potential of the long-acting protocol in addressing OHSS, this study may pave the way for further advancements in ovarian stimulation techniques that prioritize participants comfort and safety. Such insights are crucial in refining IVF protocols and enhancing participant experiences in ART.

Coi Statement

The authors declare that there is no conflict of interest.

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