Efficacy and Safety of In Vitro Fertilization (IVF)/Intracytoplasmic Sperm Injection (ICSI) Among Patients with Endometriosis After a Shortened Protocol of Long-Term Pituitary Downregulation

Abstract

Background Patients with endometriosis (EMs) are routinely advised to take GnRH-a for 3–6 months to improve the internal reproductive environment, but this may not be necessary. Material/Methods This retrospective study examined the effects of in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) with shortened (n=311) or conventional (n=213) long-term pituitary downregulation in EMs patients between January 2013 and July 2017. Results The 2 groups showed no significant differences in gonadotropin (Gn) dose, number of oocytes retrieved, or miscarriage rate. Follicle-stimulating hormone (FSH), luteinizing hormone (LH), and estradiol (E2) levels on the initiation day and the LH level on human chorionic gonadotropin (hCG) day (1.22±1.39 vs. 0.74±0.55 P=0.0026) were higher in the study group than in the control group. The cumulative live birth rates in the second cycle were 69.13% in the study group (95% confidence interval (CI), 64–74.27%) vs. 68.54% in the control group (95% CI, 62.31–74.78%, P=0.88, respectively). Conclusions This study showed that the shortened regimen and the ultralong regimen did not produce different pregnancy outcomes after ART, and the single-application, long-term GnRH-a protocol may serve as a cost-effective and safe treatment protocol for EMs patients.

Ultralong administration of gonadotropin-releasing hormone agonists before in vitro fertilization improves fertilization rate but not clinical pregnancy rate in women with mild endometriosis: a prospective, randomized, controlled trial

“…The quality of embryos, IR, and clinical PR were not statistically significant different among the women with endometriosis who received or did not receive the regimen. Supporting our data, a recent retrospective study showed that the shortened regimen and the ultralong regimen did not produce different pregnancy outcomes after ART (33).…”

Effectiveness of ultra‐long protocol on in vitro fertilization/intracytoplasmic sperm injection‐embryo transfer outcome in infertile women with endometriosis: A systematic review and meta‐analysis of randomized controlled trials

“…[ 11 ] A retrospective study reported that a 2‐month downregulation did not produce different pregnancy outcomes after ART. [ 25 ] But there was no published RCT that compare a 2‐month downregulation with long protocol.…”

Long-Acting GnRH Agonist Improves IVF Outcomes of Young Patients with Diminished Ovarian Reserve by Increasing Endometrial Receptivity.

“…We have carefully reviewed these papers, and found that the pituitary desensitization time of long-acting and short-acting GnRH agonist were same and short from 14 to 21 days before ovarian stimulation. Recently, the novel ovarian stimulation protocol, long-acting GnRH agonist long protocol in follicular phase, was proposed in IVF cycle [14][15][16][17][18][19]. In this protocol, the duration of pituitary desensitization is extended to more than one month before ovarian stimulation.…”

“…Recently, long-acting GnRH agonist long protocol in follicular phase is proposed in controlled ovarian stimulation of IVF cycle [14][15][16][17][18][19]. During this protocol, a long-acting GnRH agonist triptorelin is given as a single dose for pituitary desensitization on day 2-3 of menstrual cycle.…”

“…As we all know, long-term pituitary down-regulation before IVF could improve pregnancy outcomes in women with endometriosis [14,15,20,21]. Therefore, in our center, long-acting GnRH agonist protocol in follicular phase was primarily used for patients with endometriosis.…”