Gonadotropin-Releasing Hormone agonist (GnRH-a) Pretreatment before Hormone Replacement Therapy Does Not Improve Reproductive Outcomes of Frozen–Thawed Embryo Transfer Cycle in Older Patients with Intrauterine Fibroid: A Retrospective Cohort Study

Abstract

Background: Surgery in elder patients with intermural fibroids delays pregnancy, and GnRH-a can shrink uterine fibroids to a certain extent; therefore, for geriatric patients with fibroids, determining whether GnRH-a pretreatment before frozen–thawed embryo transfer (FET) can improve its success rate remains to be studied. We conducted this study to research whether GnRH-a pretreatment before hormone replacement treatment (HRT) could optimize the reproductive outcomes compared with others preparations in geriatric patients with intramural fibroids. Methods: According to the endometrial preparation, patients were divided into a GnRH-a–HRT group, a HRT group and a natural cycle (NC) group. The live birth rate (LBR) was the first outcome, and the clinical pregnancy outcome (CPR), the miscarriage rate, the first trimester abortion rate and the ectopic pregnancy rate were the secondary outcomes. Results: A total of 769 patients (aged 35 years or older) were included in this study. No significant difference was observed in the live birth rate (25.3% vs. 17.4% vs. 23.5%, p = 0.200) and the clinical pregnancy rate (46.3% vs. 46.1% vs. 55.4%, p = 0.052) among the three endometrial preparation regimens. Conclusion: In this study, for the geriatric patient with the intramural myoma, the pretreatment with GnRH-a did not show any advantage over the NC and HRT preparation groups before the FET, and the LBR was not significantly increased.

Pregnancy outcomes of 4 endometrial preparation protocols in adenomyosis patients with thin endometrium during frozen embryo transfer: a retrospective cohort study

“…And dydrogesterone 40 mg/d was added to simulate the menstrual cycle secretory phase. Embryo transfer was performed 5–7 days later, according to the physician’s discretion 16,17 . HRT with GnRH-a pretreatment (GnRH-a+HRT): In the GnRH-a–HRT regimen, on days 1–4 of the menstrual period, patients were injected with 3.75 mg of GnRH-a to downregulate the function of the pituitary. After about 30 days, we evaluated whether patients had reached the pituitary downregulation status by evaluating ultrasound and hormone levels.…”

“…Embryo transfer took place 3–5 days after ovulation. Administration of oral dydrogesterone tablets at a dosage of 20 mg per day is added from the ovulation day or the first day after ovulation until the completion of the 12th week of pregnancy, after which the medication is to be discontinued 16,17 .…”

“…The standard criteria for pituitary downregulation are as follows: luteinizing hormone <5IU/L, uterine endometrial thickness <5 mm, estrogen (E2) <50 pg/mL, and no large follicles. When the standard criteria were reached, hormone replacement followed, as described in the HRT regimen 16,17 . Ovulation induction: patients received intramuscular injections of human menopausal gonadotropin from the second day to the fifth day of menstruation. The initial dosage was determined based on the ovarian response and body weight of the patients and was adjusted according to the follicle size observed via vaginal ultrasound and the hormone levels of the patients.…”

“…And dydrogesterone 40 mg/d was added to simulate the menstrual cycle secretory phase. Embryo transfer was performed 5–7 days later, according to the physician’s discretion 16,17 .…”

“…The standard criteria for pituitary downregulation are as follows: luteinizing hormone <5IU/L, uterine endometrial thickness <5 mm, estrogen (E2) <50 pg/mL, and no large follicles. When the standard criteria were reached, hormone replacement followed, as described in the HRT regimen 16,17 .…”