Prolonged pituitary down-regulation with full-dose of gonadotropin-releasing hormone agonist in different menstrual cycles: a retrospective cohort study

Abstract

Background The efficiency of prolonged down-regulation caused by a full-dose of gonadotropin-releasing hormone agonist (GnRH-a) injected during different menstrual phases has not yet been researched. Our goal was to evaluate the effects of GnRH-a, which was used in different phases of the menstrual cycle in patients undergoing in vitro fertilization and embryo transfer. Methods This was a retrospective cohort study. A total of 320 patients received a prolonged pituitary down-regulated full-dose (3.75 mg) of triptorelin in the early follicular phase, and 160 patients received the same full-dose of triptorelin during the mid-luteal phase. Clinical and laboratory outcomes were compared between the two groups. Results The basic characteristics of the two groups were comparable. The mean number of retrieved oocytes, fertilized oocytes, cleavage oocytes and good quality embryos were comparable between the two groups. Although there was a higher antral follicle count, cyst formation rate, fertilization rate and cleavage rate in the follicular phase group, no statistically significant effects were seen on implantation rate (41.15% vs. 45.91%), clinical pregnancy rate (60.38% vs. 61.36%), ongoing pregnancy rate (57.74% vs. 57.58%), live birth rate (56.23% vs. 57.58%) or early abortion rate (2.64% vs. 3.79%) per fresh transfer cycle. Moreover, severe ovarian hyperstimulation syndrome rates at the early stage (1.89% vs. 2.27%) were low in both groups. Conclusions Prolonged pituitary down-regulation achieved by utilizing a full-dose of GnRH-a administrated in either phase of the menstrual cycle can have a positive effect on ongoing pregnancy rate and live-birth rate per fresh embryo transfer cycle. Ovarian cyst formation rate was higher in the follicular phase group, but this did not have any adverse impact on clinical results.

Clinical and perinatal outcomes of fresh single-blastocyst-transfer cycles under an early follicular phase prolonged protocol according to day of trigger estradiol levels

“…Prolonged pituitary down-regulation before starting Gn resulted in higher live-birth rates during fresh embryo transfer due to the greater endometrial receptivity during embryo implantation (Ren et al, 2014;Tian et al, 2019). In our previous study, we found one GnRH-a depot across different fresh embryo transfer menstrual cycles, which was consistent with the findings of Ying et al (2019). However, few studies have further explored how E 2 levels influence fresh SBT's clinical and maternal-fetal perinatal outcomes under this protocol.…”

“…Patients that have been treated with long-acting GnRHa during COH have shown good compliance and clinical pregnancy rates (Gao et al, 2014;Liao et al, 2015). Our previous study also showed encouraging clinical outcomes for long-acting GnRH-a, regardless of the patient's menstrual cycle time (Ying et al, 2019).…”

“…The embryo culture program has been previously described and the embryo scoring standard referred to the 2011 Istanbul Consensus (Embryology ASiRMaESIGo, 2011; Ying et al, 2019). A blastomere with seven to nine cells of an A or B grade was considered a good quality D3 blastomere.…”

Analysis of the Number of Euploid Embryos in Preimplantation Genetic Testing Cycles With Early-Follicular Phase Long-Acting Gonadotropin-Releasing Hormone Agonist Long Protocol

“…Over the last 5 years, the EFLL protocol has been increasingly used in China for IVF patients because of its potential to yield higher pregnancy and live-birth rates ( 13 , 14 , 19 , 20 ). The success of this protocol has been attributed to its improvement of the quality of the endometrium or the embryo.…”

Divergent expression patterns of pituitary gonadotropin subunit and GnRH receptor genes to continuous GnRH in vitro and in vivo

“…Several physiological responses and pathological conditions that cause reproductive failure in humans are also associated with dysregulation of pulsatile GnRH release, including functional hypothalamic amenorrhea, hyperprolactinemia, polycystic ovary syndrome, and hypogonadotropic hypogonadism 7–10 . Continuous GnRH receptor agonist treatments are also clinically relevant, for example, for prevention of ovarian hyperstimulation syndrome during assisted reproduction 11,12 , for ovarian protection during chemotherapy 13 , and for treatments of precocious puberty 14 and polycystic ovary syndrome 15 .…”