Gonadotrophin-releasing hormone agonist and antagonist: factors driving the pregancy outcomes – An exploratory analysis

Abstract

ObjectiveA recent Cochrane review has demonstrated that gonadotrophin-releasing hormone agonists and antagonists have similar pregnancy outcomes, but a better safety profile for GnRH antagonists. Even so, little is known on how factors such as type of GnRH antagonist and flexibility in administration affects the pregnancy outcomes.DesignSystematic review/ meta-analysis.Materials and MethodsUsing data from recent Cochrane review (Al-Inany et al., 2011), RCTs comparing antagonist versus agonist were grouped according to the type of GnRH used (e.g. Cetrorelix or Ganirelix) and flexibility of the protocol (e.g. fixed or flexible protocol). Indirect comparisons were performed using the Bucher method and adjusted point estimates and confidence intervals were evaluated. The primary outcome was the live-birth rate. The secondary outcomes were the ongoing pregnancy and clinical pregnancy rates.ResultsTabled 1Clinical outcomes.Cetrorelix vs. AgonistGanirelix vs. AgonistCetrorelix vs. GanirelixFlexible protocol vs. AgonistFixed protocol vs. AgonistFlexible protocol vs. Fixed protocolLive-birth rate0.87 [0.63, 1.20]0.65 [0.26, 1.62]1.34 [0.51, 3.53]NANANAOngoing-pregnancy rate0.92 [0.72, 1.17]0.88 [0.74, 1.05]1.05 [0.78, 1.41]0.98 [0.79, 1.22]0.87 [0.71, 1.06]1.13 [0.84, 1.51]Clinical pregnancy rate0.86 [0.69, 1.07]0.91 [0.76, 1.09]0.95 [0.71, 1.26]0.96 [0.76, 1.20]0.88 [0.72, 1.07]1.09 [0.81, 1.48] Open table in a new tab ConclusionThe type of antagonist and flexibility of the antagonist protocol do not seem to be detriemental factors in the sucess of GnRH antagonists. ObjectiveA recent Cochrane review has demonstrated that gonadotrophin-releasing hormone agonists and antagonists have similar pregnancy outcomes, but a better safety profile for GnRH antagonists. Even so, little is known on how factors such as type of GnRH antagonist and flexibility in administration affects the pregnancy outcomes. A recent Cochrane review has demonstrated that gonadotrophin-releasing hormone agonists and antagonists have similar pregnancy outcomes, but a better safety profile for GnRH antagonists. Even so, little is known on how factors such as type of GnRH antagonist and flexibility in administration affects the pregnancy outcomes. DesignSystematic review/ meta-analysis. Systematic review/ meta-analysis. Materials and MethodsUsing data from recent Cochrane review (Al-Inany et al., 2011), RCTs comparing antagonist versus agonist were grouped according to the type of GnRH used (e.g. Cetrorelix or Ganirelix) and flexibility of the protocol (e.g. fixed or flexible protocol). Indirect comparisons were performed using the Bucher method and adjusted point estimates and confidence intervals were evaluated. The primary outcome was the live-birth rate. The secondary outcomes were the ongoing pregnancy and clinical pregnancy rates. Using data from recent Cochrane review (Al-Inany et al., 2011), RCTs comparing antagonist versus agonist were grouped according to the type of GnRH used (e.g. Cetrorelix or Ganirelix) and flexibility of the protocol (e.g. fixed or flexible protocol). Indirect comparisons were performed using the Bucher method and adjusted point estimates and confidence intervals were evaluated. The primary outcome was the live-birth rate. The secondary outcomes were the ongoing pregnancy and clinical pregnancy rates. ResultsTabled 1Clinical outcomes.Cetrorelix vs. AgonistGanirelix vs. AgonistCetrorelix vs. GanirelixFlexible protocol vs. AgonistFixed protocol vs. AgonistFlexible protocol vs. Fixed protocolLive-birth rate0.87 [0.63, 1.20]0.65 [0.26, 1.62]1.34 [0.51, 3.53]NANANAOngoing-pregnancy rate0.92 [0.72, 1.17]0.88 [0.74, 1.05]1.05 [0.78, 1.41]0.98 [0.79, 1.22]0.87 [0.71, 1.06]1.13 [0.84, 1.51]Clinical pregnancy rate0.86 [0.69, 1.07]0.91 [0.76, 1.09]0.95 [0.71, 1.26]0.96 [0.76, 1.20]0.88 [0.72, 1.07]1.09 [0.81, 1.48] Open table in a new tab ConclusionThe type of antagonist and flexibility of the antagonist protocol do not seem to be detriemental factors in the sucess of GnRH antagonists. The type of antagonist and flexibility of the antagonist protocol do not seem to be detriemental factors in the sucess of GnRH antagonists.