Abstract

Gonadotropin-releasing hormone agonist (GnRH-a) is generally added to the improve pregnancy outcomes of hormone replacement therapy cycles among patients with adenomyosis. We aimed to investigate whether adding GnRH-a can result in better pregnancy outcomes. This retrospective analysis included 341 patients with adenomyosis who underwent frozen embryo transfer (FET) after in vitro fertilization (IVF). The control group was treated only with hormone replacement therapy cycles to prepare the endometrium, and GnRH-a was added to the study group before hormone administration to adjust the menstruation cycle. Based on the similar baseline values and embryological data, there was no significant difference in the clinical pregnancy rates (40.63% vs. 42.54%, P = 0.72) and live birth rates (23.75% vs. 23.75%, P = 0.74) of the control and study groups. Other secondary outcomes, including the rates of clinical miscarriage, ectopic pregnancy, preterm birth and term birth, were not significantly different between the two groups. Compared with the hormone replacement therapy cycle alone, GnRH-a downregulation based on a hormone replacement therapy cycle may not increase the rate of clinical pregnancy or live birth of IVF-ET with FET among infertile patients with adenomyosis.

Highlights

  • Adenomyosis is a condition in which endometrium-like epithelial and stromal tissues are present outside the endometrium and invade into the myometrium

  • One hundred and sixty females in Group A underwent Gonadotropin-releasing hormone agonist (GnRH-a) downregulation treatment based on the hormone replacement therapy cycle, and the other one hundred eightyone patients in Group B were treated only with hormone replacement therapy

  • There were no obvious effects of Gonadotropin-releasing hormone (GnRH)-a on the pregnancy outcomes of patients with adenomyosis

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Summary

Introduction

Adenomyosis is a condition in which endometrium-like epithelial and stromal tissues are present outside the endometrium and invade into the myometrium. In assisted reproductive technology (ART), GnRH-a has been widely used in patients with endometriosis for frozen or fresh embryo transfer to improve pregnancy o­ utcomes[6,7,8,9]. Another study found that, regarding fresh and frozen embryo transfer (FET), GnRH-a was beneficial only for fertilization rates but not clinical pregnancy rates among women with e­ ndometriosis[10]. In the context of adenomyosis, GnRH-a has been used for pituitary downregulation to improve reproductive conditions in ART. Several studies have shown the potential efficacy of adding GnRH-a to the treatment course in terms of pregnancy outcomes among women who undergo IVF/ICSI, and they support the use GnRH-a downregulation to improve the success rates of IVF/ICSI involving fresh embryo transfer or ­FET13–15

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