Abstract
ObjectivesTo evaluate the effects of the addition of single-dose GnRH agonist to the routine progestogens use for luteal phase support on IVF outcome as compared to progestogens only.MethodsThis is a retrospective case-control study on selected patients who underwent IVF treatment with fresh embryo transfer (ET) under Medically Assisted Conception Unit, University Kebangsaan Malaysia Medical Center for the period of June 2015–June 2018. A higher dose of 0.2 mg subcutaneous Decapeptyl was administered 2 days before fresh ET concurrent with routine progestogen support. Patients with different luteal phase regimes, frozen embryo transfer and medical records with missing data were excluded. Their medical records were reviewed, and data analyzed. The pregnancy outcomes measured included biochemical pregnancy rates, clinical pregnancy rates, live birth rates and miscarriage rates.ResultsA total of 786 patients were analyzed. Four hundred forty-four patients were given luteal phase support with progestogens and GnRH agonist, whereas 342 patients served as control were given progestogens only. The study group showed higher biochemical pregnancy rate (47.7 vs. 44.4%,), clinical pregnancy rate (25.7 vs. 23.4%) and livebirth rate (24.3 vs. 22.2%), respectively but not statistically significant. The rate of miscarriage among the study group was lower (4.5% vs 9.4%) compared to the progestogen group alone. Nonetheless, the OHSS rate was slightly increased in the study group (4.5 vs. 3.5%) despite using a mild stimulation protocol.ConclusionsNew regime of GnRH agonist luteal support in addition to the standard progestogen support was found to be beneficial in overall IVF outcome.
Highlights
It is estimated that approximately 15% of the population, or one in six to seven couples in the western world experienced an unwanted delay in conception
Four hundred forty-four patients were given luteal phase support with progestogens and GnRH agonist, whereas 342 patients served as control were given progestogens only
New regime of GnRH agonist luteal support in addition to the standard progestogen support was found to be beneficial in overall IVF outcome
Summary
It is estimated that approximately 15% of the population, or one in six to seven couples in the western world experienced an unwanted delay in conception. Assisted reproduction treatment (ART) enables couples to conceive and give birth to a healthy baby. The treatment cycle for IVF involves several steps from pituitary down-regulation to ovarian stimulation, ovulation trigger, oocyte collection, luteal phase support, and embryo transfer. One of the primary concerns was luteal phase deficiency which was described in cycles using pituitary down-regulation with a GnRH agonist, GnRH antagonist and currently with minimal stimulation regime [1, 2]. Luteal phase deficiency is characterized by premature regression of the corpus luteum, leading to a shortened luteal phase with evidence of low progesterone levels and delay of the secretory transformation of the endometrium leading to poor ART outcome [3]. The luteal phase support is a common practice in ART which has been proven to improve ART results by using various routes of progestogens with or without estrogen [4]
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