Experimental research Comparisons of the effects of long-acting and short-acting GnRH agonists on embryo quality, endometrial thickness and pregnancy rate in human in vitro fertilization

Abstract

IntroductionThe aim was to compare the efficacy of long-acting and short-acting gonadotropin-releasing hormone (GnRH) agonists by long protocol on embryo quality, endometrial thickness and pregnancy rate in in vitro fertilization.Material and methodsIn this retrospective study, long-term pituitary downregulation, achieved with long- and short-acting GnRH agonists (GnRHa), was performed for patients undergoing in vitro fertilization (n = 175).ResultsThere were no significant differences between the long and short-acting GnRH group (63.16% vs. 66.26%, p > 0.05), and the secondary and primary infertility group (63.47% vs. 66.86%, p > 0.05) in embryo quality. Logistic regression analysis showed that type of infertility and endometrial thickness were significantly associated with pregnancy outcome. Patients in the long-acting GnRHa group had a thicker endometrium on the day of human chorionic gonadotrophin (hCG) administration (10.79 ±2.62 mm vs. 9.64 ±1.97 mm, p < 0.01), lower serum luteinizing hormone (LH) concentration (1.21 ±1.13 vs. 2.53 ±3.39) and a higher pregnancy rate (59.60% vs. 43.42%, p < 0.05) than those of patients in the short-acting GnRHa group.ConclusionsThis work suggests that types of agonist protocol and infertility may not affect embryo quality. Type of infertility and endometrial thickness may be positive predictors for clinical pregnancy, but the key finding is that the long-acting GnRHa protocol may be an effective method of improving endometrial thickness, endometrial receptivity and pregnancy rate in in vitro fertilization.

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

“…In this protocol, the duration of pituitary desensitization is extended to more than one month before ovarian stimulation. Several studies have demonstrated that this prolonged pituitary down-regulation protocol can signi cantly improve IVF cycle outcomes compared with other protocols including short-acting GnRH agonist long protocol [16][17][18][19]. Moreover, administration of long-acting GnRH agonist for 2-6 months pre-IVF cycle in this endometriosis patient population resulted in signi cantly higher clinical pregnancy rates, ongoing pregnancy rates and live birth rates [30][31][32].…”

“…Longacting GnRH agonist long protocol in follicular phase is a novel ovarian stimulation protocol. Recently, some studies found that this protocol may improve endometrial receptivity and clinical outcomes of IVF [16][17][18][19].…”

“…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.…”

“…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. Some studies have shown that this protocol could signi cantly improve endometrial receptivity and clinical outcomes compared with other protocols [16][17][18][19].…”

“…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.…”