Effect of prolonged gonadotropin-releasing hormone agonist therapy on the outcome of in vitro fertilization-embryo transfer in patients with endometriosis
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Abstract
To evaluate the effect of a 3-month course of GnRH agonist administered immediately
before IVF-ET in infertile patients with endometriosis.
Prospective, randomized trial.
Three tertiary care assisted reproductive technology programs.
IVF-ET candidates with surgically confirmed endometriosis.
Twenty-five patients received three courses of a long-acting GnRH agonist, 3.75 mg
i.m. every 28 days, followed by standard controlled ovarian hyperstimulation. Twenty-six
patients received standard controlled ovarian hyperstimulation with mid-luteal phase
GnRH agonist down-regulation or microdose flare regimens.
Response to controlled ovarian hyperstimulation, ongoing pregnancy rates per cycle,
group implantation rates, and implantation rate per embryo transfer procedure.
The extent of surgically confirmed endometriosis was greater in patients who received
the long-acting GnRH regimen for 3 months before IVF-ET. The groups did not differ
significantly in terms of dose or duration of gonadotropin stimulation, number of
oocytes retrieved, fertilization rate, or number of embryos transferred. Patients
who received the long-acting GnRH regimen had significantly higher ongoing pregnancy
rates (80% vs. 53.85%) and a trend toward higher implantation rates (42.68% vs. 30.38%).
Prolonged use of GnRH agonist before IVF-ET in patients with endometriosis resulted
in significantly higher ongoing pregnancy rates than did standard controlled ovarian
hyperstimulation regimens. No deleterious effect on ovarian response was observed.