Abstract
BackgroundEndometriosis affects the responsiveness to ovarian stimulation. This study aimed to assess the role of Dienogest pretreatment for endometriosis suppression as compared to Gonadotropin-releasing hormone agonist (GnRHa) in patients with endometriosis pursuing IVF treatment.MethodsIn this randomized controlled trial, 134 women with endometriosis-related infertility were randomly allocated to group A (n = 67) who had monthly depot GnRHa for 3 months before ovarian stimulation in IVF treatment (Ultra-long protocol), and Group B (n = 67) who had daily oral Dienogest 2 mg/d for 3 months before starting standard long protocol for IVF. The primary outcome measure was the number of oocytes retrieved. The secondary outcome measures included the number of mature oocytes, fertilization rate, quality of life assessed by FertiQoL scores, cost of treatment, and pregnancy outcomes.ResultsAlthough there was no statistically significant difference between both groups regarding ovarian stimulation, response parameters, and pregnancy outcomes, the Dienogest group had a lower cost of treatment (2773 vs. 3664 EGP, P < 0.001), lower side effects (29.9% vs. 59.7%, P < 0.001), higher FertiQoL treatment scores (33.2 vs. 25.1, P < 0.001) and higher tolerability scores (14.1 vs. 9.4, P < 0.001 < 0.001).ConclusionOur study indicates that Dienogest is a suitable and safe substitute for GnRHa pretreatment in endometriosis patients.Trial registrationNCT04500743 “Retrospectively registered on August 5, 2020”.
Highlights
Endometriosis affects the responsiveness to ovarian stimulation
Its use alone without adding back hormonal therapy should be to a maximum of 6 months as long-term use of GnRH agonist (GnRH-a) is associated with hypoestrogenic adverse effects, such as hot flushes, vaginal dryness, decreased libido, and decreased bone mineral density [6]
Women were excluded if they have been already on long-term downregulation of the pituitary gland with Gonadotropin-releasing hormone agonist (GnRHa) for control of endometriosis or if they have liver or kidney disease precluding the use of Dienogest or have evidence of diminished ovarian reserve
Summary
Endometriosis affects the responsiveness to ovarian stimulation. This study aimed to assess the role of Dienogest pretreatment for endometriosis suppression as compared to Gonadotropin-releasing hormone agonist (GnRHa) in patients with endometriosis pursuing IVF treatment. Khalifa et al BMC Pregnancy and Childbirth (2021) 21:264 state, causing suppression of endometriotic lesions This has led to the use of long-acting depot GnRH-a preparation for control of pelvic pain and other endometriosisrelated symptoms [5]. It has been proposed that long-term GnRH-a pretreatment for 3 months should be used in patients with endometriosis before IVF treatment to suppress any endometriotic lesions [7]. This so-called ultra-long protocol has been suggested to improve the pregnancy rates in endometriosis patients after IVF compared with other protocols for pituitary downregulation. The relatively long period of hypo-estrogenic side effects associated with an ultralong protocol with a potential need for higher doses of gonadotropins and recent evidence from Cochrane review showing inconclusive evidence of benefit has led to research into better alternatives for control of endometriosis before IVF [9]
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