Intra-muscular long acting GnRH agonist(decapeptyle®cr,triptorelin 3.75)injection on the first day of the menstral cycle increases the thickness of resisting thin endometrium

Abstract

To evaluate the flare-up effect of an intra-muscular injection of long-acting GnRH agonist on the first day of the menstrual cycle to increase the thickness of resisting thin endometrium and improve pregnancy outcome. Prospective Cohort, Proof of concept study. This prospective cohort study was conducted in a large private art center in 510 infertile patients with successive implantation failures and resisting thin endometrium. Being recipients of fresh donor or frozen embryos from Jan 2004-2014. Long-acting GnRH agonist was injected on the first day of the cycle also oral Conjugated estrogens USP(EQIN-ActoverCo) was started at 1.25mg and increased to a maximum daily dose of 3.75 mg. Endometrial thickness was controlled with ultrasound and progesterone was initiated . Mean endometrial thickness was increased from 5.3 mm to 6.1 mm (p= 0.007). 36% of the patients had more than 25% improvement of their endometrial thickness. 18% achieved an endometrial thickness above 7mm and in 18% endometrial thickness did not improved at all. overall The live birth rate was 39% (198/510). To our knowledge this is the first study to investigate the possible consequences of a flare-up of intra-muscular injection of long acting GnRH agonist on the first day of the menstrual cycle to increase endometrial thickness and prevent cycle cancellation and improve pregnancy rate. Further studies are needed to clarify whether this effect only associated with flare-up effect of long-acting GnRH or other mechanisms are involved.