Abstract
BackgroundRecent studies have indicated the use of gonadotropin-releasing hormone antagonists (GnRH-ant) as an adjuvant treatment to prevent premature luteinization (PL) and improve the clinical outcomes in patients undergoing controlled ovarian stimulation (COS) with intrauterine insemination (IUI). However, the results of these studies are conflicting.MethodsWe conducted a systematic review and meta-analysis of randomized trials aiming to compare the clinical efficacy of GnRH-ant in COS/IUI cycles. Twelve studies were identified that met inclusion criteria and comprised 2,577 cycles assigned to COS/IUI combined GnRH-ant or COS/IUI alone.ResultsMeta-analysis results suggested that GnRH-ant can significantly increase the clinical pregnancy rate (CPR) (OR = 1.42; 95% CI, 1.13–1.78) and decrease the PL rate (OR = 0.22, 95% CI, 0.16–0.30) in COS/IUI cycles. Subgroup analysis results suggested statistically significant improvement in the CPR in non-PCOS patients (OR = 1.54; 95% CI, 1.03–2.31) but not in the PCOS population (OR = 1.65; 95% CI, 0.93–2.94) and multiple mature follicle cycles (OR = 1.87; 95% CI, 0.27–12.66). There were no difference in the miscarriage and multiple pregnancy rates between the groups.ConclusionThis meta-analysis suggested that GnRH-ant can reduce the incidence of PL and increase the CPR when used in COS/IUI cycles, and it was especially useful for non-PCOS patients. However, evidence to support its use in PCOS patients is still insufficient
Highlights
Intrauterine insemination (IUI) combined with controlled ovarian stimulation (COS) with low-dose recombinant FSH is widely used in the treatment of unexplained, endometriosis or male factor infertility because of the higher pregnancy rates associated with this approach compared to intrauterine insemination (IUI) cycles without COS or those with clomiphene citrate stimulation [1,2,3,4]
On examination of the manuscripts, eight studies were excluded [11,12,13,14,15,16,17,18]: three were not prospective randomized trials [11,12,13], two compared different gonadotropin doses [14,15], one compared different doses of GnRH-ant [16], and the remaining two aimed to study the effectiveness of GnRH-ant in COS/IUI cycles to avoid IUI on weekends [17,18]. The aims of the latter two studies were inconsistent with the aim of our meta-analysis, and postponing IUI to ensure that it is not carried out on weekends itself may make the physicians miss the best operation time and compromise the clinical outcome; these two studies were not included into our meta-analysis
This review aimed to explore the efficacy of GnRH-ant when used as an adjuvant to COS/IUI cycles
Summary
Intrauterine insemination (IUI) combined with controlled ovarian stimulation (COS) with low-dose recombinant FSH (rFSH) is widely used in the treatment of unexplained, endometriosis or male factor infertility because of the higher pregnancy rates associated with this approach compared to IUI cycles without COS or those with clomiphene citrate stimulation [1,2,3,4]. Gonadotropin-releasing hormone antagonists (GnRH-ant) have been successfully used in IVF cycles to prevent premature LH surge for many years [8]. Their suppressive effect on the secretion of gonadotropins from the pituitary is mediated immediately after administration. Many research groups have investigated the use of GnRH-ant in women undergoing COS/IUI treatment to determine its benefits in improving the reproductive outcomes. Recent studies have indicated the use of gonadotropin-releasing hormone antagonists (GnRH-ant) as an adjuvant treatment to prevent premature luteinization (PL) and improve the clinical outcomes in patients undergoing controlled ovarian stimulation (COS) with intrauterine insemination (IUI).
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