The effects of GnRH antagonist vs. GnRH agonist down regulation on the outcome of IUI cycles

Abstract

ObjectiveIt has been shown that up to 24% of non-down-regulated COH/IUI cycles may suffer premature luteinization. The use of down-regulation in controlled ovarian hyperstimulation (COH)/IUI cycles has improved pregnancy rates as compared to non-down-regulated cycles. The aim of this study is to compare the efficacy of GnRH antagonist to GnRH agonist down-regulation in COH/IUI cycles.DesignHistorical cohort study.Materials and methodsTable 1Comparison of GnRH agonist cycles to GnRH antagonist cycles outcomeGnRH agonist (n − 1258)GnRH antagonist (n − 626)Total (n = 1884)PPregnancy353 (28.1%)199 (31.9%)552 (29.3%)NSDelivery276 (21.9%)163 (26.0%)439 (23.3%)NSMiscarried63 (17.8%)26 (13.1%)89 (16.1%)NSEctopic14 (4.05)10 (5.0%)24 (4.3%)NS Open table in a new tab ResultsThe mean age for all the women was 32 ± 4.5 years. There was no significant difference in the mean age between the two groups. However, the mean duration of infertility was significantly longer (P=0.01) and the proportion of primary infertility was significantly greater (P=0.02) in the GnRH antagonist group. The mean number of follicles ≥16 mm (4.9 ± 3.0 compared to 4.2 ± 2.6) and the mean peak estradiol (E2) (1480 ± 850 pg/ml compared to 1210 ± 810 pg/ml)were significantly greater in the GnRH agonist group compared to the GnRH antagonist group (P=0.001 and P=0.01 respectively). After multiple logistic regression analyses, the type of infertility and the number of 16 mm follicles remained significant factors. The pregnancy rates in the 2 groups were similar (31.9% and 28.1% for group 1 and group 2 respectively). The delivery, miscarriage and ectopic pregnancy rates were similar in the 2 groups (Table 1).ConclusionsBoth GnRH Antagonist and GnRH agonist appear to have similar effectiveness during COH/IUI cycles. ObjectiveIt has been shown that up to 24% of non-down-regulated COH/IUI cycles may suffer premature luteinization. The use of down-regulation in controlled ovarian hyperstimulation (COH)/IUI cycles has improved pregnancy rates as compared to non-down-regulated cycles. The aim of this study is to compare the efficacy of GnRH antagonist to GnRH agonist down-regulation in COH/IUI cycles. It has been shown that up to 24% of non-down-regulated COH/IUI cycles may suffer premature luteinization. The use of down-regulation in controlled ovarian hyperstimulation (COH)/IUI cycles has improved pregnancy rates as compared to non-down-regulated cycles. The aim of this study is to compare the efficacy of GnRH antagonist to GnRH agonist down-regulation in COH/IUI cycles. DesignHistorical cohort study. Historical cohort study. Materials and methodsTable 1Comparison of GnRH agonist cycles to GnRH antagonist cycles outcomeGnRH agonist (n − 1258)GnRH antagonist (n − 626)Total (n = 1884)PPregnancy353 (28.1%)199 (31.9%)552 (29.3%)NSDelivery276 (21.9%)163 (26.0%)439 (23.3%)NSMiscarried63 (17.8%)26 (13.1%)89 (16.1%)NSEctopic14 (4.05)10 (5.0%)24 (4.3%)NS Open table in a new tab ResultsThe mean age for all the women was 32 ± 4.5 years. There was no significant difference in the mean age between the two groups. However, the mean duration of infertility was significantly longer (P=0.01) and the proportion of primary infertility was significantly greater (P=0.02) in the GnRH antagonist group. The mean number of follicles ≥16 mm (4.9 ± 3.0 compared to 4.2 ± 2.6) and the mean peak estradiol (E2) (1480 ± 850 pg/ml compared to 1210 ± 810 pg/ml)were significantly greater in the GnRH agonist group compared to the GnRH antagonist group (P=0.001 and P=0.01 respectively). After multiple logistic regression analyses, the type of infertility and the number of 16 mm follicles remained significant factors. The pregnancy rates in the 2 groups were similar (31.9% and 28.1% for group 1 and group 2 respectively). The delivery, miscarriage and ectopic pregnancy rates were similar in the 2 groups (Table 1). The mean age for all the women was 32 ± 4.5 years. There was no significant difference in the mean age between the two groups. However, the mean duration of infertility was significantly longer (P=0.01) and the proportion of primary infertility was significantly greater (P=0.02) in the GnRH antagonist group. The mean number of follicles ≥16 mm (4.9 ± 3.0 compared to 4.2 ± 2.6) and the mean peak estradiol (E2) (1480 ± 850 pg/ml compared to 1210 ± 810 pg/ml)were significantly greater in the GnRH agonist group compared to the GnRH antagonist group (P=0.001 and P=0.01 respectively). After multiple logistic regression analyses, the type of infertility and the number of 16 mm follicles remained significant factors. The pregnancy rates in the 2 groups were similar (31.9% and 28.1% for group 1 and group 2 respectively). The delivery, miscarriage and ectopic pregnancy rates were similar in the 2 groups (Table 1). ConclusionsBoth GnRH Antagonist and GnRH agonist appear to have similar effectiveness during COH/IUI cycles. Both GnRH Antagonist and GnRH agonist appear to have similar effectiveness during COH/IUI cycles.