Long-term GnRH agonist therapy before in vitro fertilisation (IVF) for improving fertility outcomes in women with endometriosis

Ektoras X Georgiou, Pedro Melo, Philip E Baker, Philip Baker, Hassan Sallam, Hassan N Sallam, Aydin Arici, Aydın Arıcı, Juan A Garcia-Velasco, Juan A. García-Velasco, Ahmed M Abou-Setta, Christian M. Becker, Christian Becker, Ingrid E Granne, Ingrid Granne
The Cochrane database of systematic reviews · 2019 · vol. 2019(11) · doi:10.1002/14651858.cd013240.pub2 · PMID:31747470 · PMC6867786 · W2909715450
review OA: green CC0 ⤵ 82 in-corpus citations
📄 Open PDF View on OpenAlex View on PubMed View at publisher
⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

This review found insufficient evidence to determine if long-term GnRH agonist therapy before IVF improves live birth rates or complication rates in women with endometriosis compared to no pretreatment.

One-sentence paraphrase of the abstract; not a substitute for reading it. No clinical advice. How this works

⚙ AI-generated deep summary by claude@2026-06, 2026-06-10 ⓘ

This systematic review of randomized controlled trials evaluated whether long-term gonadotrophin-releasing hormone (GnRH) agonist therapy for at least 3 months before standard IVF/ICSI improves fertility outcomes in women with surgically diagnosed endometriosis, compared with no pretreatment. Eight parallel-design RCTs (640 participants) were included, and the main limitation across evidence was lack of blinding, leading to very low to low certainty (GRADE). The review found uncertainty about effects on live birth rate and multiple outcomes including clinical pregnancy, miscarriage, multiple pregnancy, oocytes, and embryos, with effect estimates imprecise and often supported by few events and heterogeneity. This paper is centrally about endometriosis—specifically the effectiveness and safety of long-term GnRH agonist pretreatment before IVF/ICSI in women with endometriosis.

Read from the paper's body, not the abstract. Not a substitute for reading the paper. No clinical advice. How this works

Abstract

BACKGROUND: Endometriosis is known to have an impact on fertility and it is common for women affected by endometriosis to require fertility treatments, including in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI), to improve the chance of pregnancy. It has been postulated that long-term gonadotrophin-releasing hormone (GnRH) agonist therapy prior to IVF or ICSI can improve pregnancy outcomes. This systematic review supersedes the previous Cochrane Review on this topic (Sallam 2006). OBJECTIVES: To determine the effectiveness and safety of long-term gonadotrophin-releasing hormone (GnRH) agonist therapy (minimum 3 months) versus no pretreatment or other pretreatment modalities, such as long-term continuous combined oral contraception (COC) or surgical therapy of endometrioma, before standard in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI) in women with endometriosis. SEARCH METHODS: We searched the following electronic databases from their inception to 8 January 2019: Cochrane Gynaecology and Fertility Specialised Register of Controlled Trials, CENTRAL via the Cochrane CENTRAL Register of Studies ONLINE (CRSO), MEDLINE, Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL). We searched trial registries to identify unpublished and ongoing trials. We also searched DARE (Database of Abstracts of Reviews of Effects), Web of Knowledge, OpenGrey, Latin American and Caribbean Health Science Information Database (LILACS), PubMed, Google and reference lists from relevant papers for any other relevant trials. SELECTION CRITERIA: Randomised controlled trials (RCTs) involving women with surgically diagnosed endometriosis that compared use of any type of GnRH agonist for at least three months before an IVF/ICSI protocol to no pretreatment or other pretreatment modalities, specifically use of long-term continuous COC (minimum of 6 weeks) or surgical excision of endometrioma within six months prior to standard IVF/ICSI. The primary outcomes were live birth rate and complication rate per woman randomised. DATA COLLECTION AND ANALYSIS: statistic. We assessed the quality of evidence using GRADE criteria. MAIN RESULTS: = 0%; very low-quality evidence). Long-term GnRH agonist therapy versus long-term continuous COC No studies reported on this comparison. Long-term GnRH agonist therapy versus surgical therapy of endometrioma No studies reported on this comparison. AUTHORS' CONCLUSIONS: This review raises important questions regarding the merit of long-term GnRH agonist therapy compared to no pretreatment prior to standard IVF/ICSI in women with endometriosis. Contrary to previous findings, we are uncertain as to whether long-term GnRH agonist therapy impacts on the live birth rate or indeed the complication rate compared to standard IVF/ICSI. Further, we are uncertain whether this intervention impacts on the clinical pregnancy rate, multiple pregnancy rate, miscarriage rate, mean number of oocytes and mean number of embryos. In light of the paucity and very low quality of existing data, particularly for the primary outcomes examined, further high-quality trials are required to definitively determine the impact of long-term GnRH agonist therapy on IVF/ICSI outcomes, not only compared to no pretreatment, but also compared to other proposed alternatives to endometriosis management.

My notes (saved in your browser only)

Condition tags

endometriosisendometrioma

MeSH descriptors

Endometriosis Fertilization in Vitro Gonadotropins Infertility, Female Pregnancy Rate Abortion, Spontaneous Abortion, Spontaneous Endometriosis Female Gonadotropins Humans Infertility, Female Infertility, Female Ovulation Induction Pregnancy Pregnancy, Multiple Pregnancy Outcome Randomized Controlled Trials as Topic Sperm Injections, Intracytoplasmic

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.

References (86)

Cited by (50)

Source provenance

europepmc
last seen: 2026-06-11T06:19:48.454388+00:00
openalex
last seen: 2026-06-10T17:14:06.276822+00:00
pubmed
last seen: 2026-05-13T22:22:22.912744+00:00
License: CC0 · commercial use OK