GnRH agonist administration in the luteal phase does not increase clinical pregnancy or implantation rates following ICSI-ET in GnRH agonist or antagonist treated ovarian stimulation cycles

Abstract

To evaluate the effect of GnRH agonist administration in the luteal phase on pregnancy and implantation rates following intracytoplasmic sperm injection–embryo transfer (ICSI-ET) in both GnRH agonist and GnRH antagonist treated stimulation cycles. We present preliminary results of an ongoing study. Prospective randomized controlled study. 251 women who underwent controlled ovarian hyperstimulation, oocyte retrieval, ICSI and ET were randomized to receive 0.1 mg triptorelin acetate (Decapeptyl, Erkim) (n = 124) or placebo (n = 127) on day 6 days after oocyte collection. Pituitary suppression was achieved with a long GnRH agonist or a fixed antagonist protocol combined with recombinant FSH. Luteal phase was supported with progesterone vaginal gel (Crinone %8). Randomization was performed with a computer generated randomization table and was stratified for pituitary suppression protocols. Patient and cycle characteristics, number and grade of transferred embryos were similar in both groups. Overall clinical pregnancy (CP) and implantation rates (IR) were not statistically different between control and GnRH groups, 48.8% vs. 43.5%, and 24% vs. 22% respectively (P>0.05 for both comparisons). In the long GnRH analog suppression subgroup CP and IR were 45.6% vs. 46.9% and 22.1% vs. 23.6% in control and GnRH groups respectively (P>0.05 for both comparisons). In the GnRH antagonist suppression subgroup CP and IRs were 54.8% vs. 33.3% and 29% vs. 16.4% in control and GnRH groups respectively (P>0.05 for both comparisons). GnRH administration in the luteal phase has been suggested as a novel luteal support and recently a randomized controlled study has been published reporting significantly higher implantation and live birth rates with a single dose of triptorelin administered on the 6th day following oocyte collection. However our study does not demonstrate any benefit of GnRH administration in the luteal phase and do not support previous findings. Additionally there is a downwards trend in CP and IR when GnRH agonist was administered following antagonist cycles which may reach significance in larger samples.