Pregnancy outcomes after controlled ovarian hyperstimulation in women with endometriosis-associated infertility: GnRH-agonist versus GnRH-antagonist

J Gynecol Obstet Hum Reprod. 2017 Nov;46(9):681-686. doi: 10.1016/j.jogoh.2017.09.007. Epub 2017 Sep 29.

Abstract

Background or objective: Endometriosis is common in women referred for infertility. In vitro fertilization provides good results but the choice of the best-controlled ovarian hyperstimulation protocol remains a subject of debate. The objective of this retrospective study was to compare pregnancy outcomes in women with endometriosis-associated infertility after COH with a long agonist protocol or a six-week oral contraception-antagonist protocol.

Material and methods: Retrospective analysis of a prospective database identified 284 COH cycles - 165 with GnRH-agonist protocol (GnRH-agonist group) and 119 with GnRH-antagonist protocol (GnRH-antagonist group) - in 218 women, with endometriosis from January 2013 to October 2015.

Results: No difference in the epidemiological characteristics was found between the groups. Per started cycle, pregnancy and live-birth rates after fresh embryo transfer were higher with the GnRH-agonist protocol (25% vs. 13%, P=0.02 and 18% vs. 8%, P=0.04, respectively). Considering analysis per cycle with embryo transfer, the pregnancy rate was similar in both groups while the live-birth rate was higher in the GnRH-agonist group (29% vs. 17%, P=0.053 and 22% vs. 10%, P=0.02, respectively). No difference was observed between the groups with freeze-thaw embryo transfer. Subgroup analysis (endometrioma alone, deep infiltrating endometriosis with and without endometrioma, endometriosis with and without adenomyosis) revealed no difference between the groups for either pregnancy or live-birth rates.

Conclusion: A GnRH-agonist protocol appears to result in higher pregnancy and live-birth rates after fresh embryo transfer in women with endometriosis-associated infertility, suggesting that a GnRH-antagonist protocol might negatively impact endometrial receptivity.

Keywords: Controlled ovarian hyperstimulation; Endometriosis; GnRH-agonist; GnRH-antagonist; In vitro fertilization (IVF); Infertility.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Endometriosis / complications
  • Endometriosis / epidemiology
  • Endometriosis / therapy*
  • Female
  • Fertility Agents, Female / therapeutic use*
  • Fertilization in Vitro
  • Gonadotropin-Releasing Hormone / agonists
  • Gonadotropin-Releasing Hormone / analogs & derivatives
  • Hormone Antagonists / therapeutic use
  • Humans
  • Infertility / epidemiology
  • Infertility / etiology
  • Infertility / therapy*
  • Male
  • Ovulation Induction / methods*
  • Ovulation Induction / statistics & numerical data
  • Pregnancy
  • Pregnancy Outcome / epidemiology*
  • Pregnancy Rate
  • Retrospective Studies
  • Sperm Injections, Intracytoplasmic
  • Uterine Diseases / complications
  • Uterine Diseases / epidemiology
  • Uterine Diseases / therapy*
  • Young Adult

Substances

  • Fertility Agents, Female
  • Hormone Antagonists
  • Gonadotropin-Releasing Hormone