Effect of GnRH agonist for luteal phase support on human endometrial receptivity after ovarian stimulation using long protocol

Abstract Background: Up to now, there is not sufficient evidence to recommend a treatment optimizing in vitro fertilization (IVF) outcomes for diminished ovarian reserve (DOR). This study is aimed to investigate whether long-acting gonadotrophin-releasing hormone (GnRH) agonist long protocol in follicular phase could improve the IVF cycle outcomes for young patients with DOR when compared with GnRH antagonist and mild ovarian stimulation protocols. Methods: This retrospective cohort study was carried out from June 2015 to March 2019. 338 patients aged 20-40 years with DOR who underwent first IVF between were enrolled. These patients were assigned to three groups depending on the ovarian stimulation protocols. The outcome parameters of IVF were compared in each group. The demographic and reproductive characteristics were calculated by Mann-Whitney, Kruskal-Wallis or chi-square test as appropriate. We evaluated the clinical outcomes of IVF cycle between the three groups using univariate and multivariate logistic regression analyses. In addition, we evaluated the morphology and coverage of pinopode and expression of HOXA10 in endometrium during implantation window between three groups by scanning electron microscope and qRT-PCR.Results: Patients who received long-acting GnRH agonist long protocol had significantly higher clinical pregnancy rates (66.67%, 42.17% and 39.02%, respectively; P=.010 and .005), implantation rates (46.15%, 29.71%, and 28.57%, respectively; P=.041 and .025) and ongoing pregnancy rates (60.00%, 34.94%, and 36.59%, respectively; P=.018 and .004). They also had significantly higher duration of stimulation, total dose of gonadotrophins and endometrial thickness than the other two groups (P＜.001). However, serum luteinizing hormone (LH) and estradiol (E2) level on gonadotrophins initiation day, serum LH level on human chorionic gonadotropin (hCG) day, the embryos transferred cancellation rate and abnormal endometrium rate were significantly lower among women who received long-acting GnRH agonist (P＜.001). In addition, we found that long-acting GnRH agonist could improve the development of pinopode and mRNA of HOXA10 (P＜.05).Conclusions: To our knowledge, this is the first time that the benefit of long-acting GnRH agonist long protocol in follicular phase in young DOR patients has been reported. Though this novel protocol may have further suppressed response, it can increase endometrial receptivity, reduce cycle cancellation rate and improve IVF cycle clinical outcomes for these patients compared with mild stimulation and GnRH antagonist protocols.

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Luteal phase oestradiol administration in ovarian stimulation cycles with GnRH antagonist is comparable to the GnRH agonist (long) protocol

Journal of Assisted Reproduction and Genetics ◽

10.1007/s10815-007-9125-x ◽

2007 ◽

Vol 24 (8) ◽

pp. 326-330 ◽

Cited By ~ 2

Author(s):

J. S. Cunha Filho ◽

L. F. Terres ◽

F. Holanda ◽

F. Freitas ◽

C. Glitz ◽

...

Keyword(s):

Gnrh Agonist ◽

Ovarian Stimulation ◽

Luteal Phase ◽

Gnrh Antagonist ◽

Long Protocol

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Effect of luteal phase support gonadotropin-releasing hormone agonist on the endometrial receptivity and outcomes of in vitro fertilization programs

GYNECOLOGY ◽

10.26442/2079-5696_18.3.48-53 ◽

2016 ◽

Vol 18 (3) ◽

Cited By ~ 1

Author(s):

E.М. Savelyeva ◽

S.G. Perminova ◽

T.A. Demura ◽

D.A. Strelchenko

Keyword(s):

In Vitro Fertilization ◽

Luteal Phase ◽

Endometrial Receptivity ◽

Gonadotropin Releasing Hormone ◽

Vitro Fertilization ◽

Releasing Hormone ◽

Luteal Phase Support ◽

Gonadotropin Releasing Hormone Agonist

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P–667 Dydrogesterone supplementation in cycles triggered with lone GnRH agonist for final oocyte maturation resulted in an acceptable pregnancy rate

Human Reproduction ◽

10.1093/humrep/deab130.666 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

M Safrai ◽

S Hertsberg ◽

A Be Meir ◽

B Reubinoff ◽

T Imbar ◽

...

Keyword(s):

Pregnancy Rate ◽

Embryo Transfer ◽

Gnrh Agonist ◽

Luteal Phase ◽

Fresh Embryo Transfer ◽

Luteal Support ◽

Luteal Phase Support ◽

Gnrh Agonist Trigger ◽

The Mean ◽

Agonist Trigger

Abstract Study question Can luteal oral Dydrogesterone (Duphaston) supplementation in an antagonist cycle after a lone GnRH agonist trigger rescue the luteal phase, allowing the possibility to peruse with fresh embryo transfer? Summary answer Functionality of the luteal phase in an antagonist cycle after a lone GnRH agonist trigger can be restored by adding Duphaston to conventional luteal support. What is known already Ovarian hyperstimulation syndrome (OHSS) is dramatically reduced when using antagonist cycle with lone GnRH agonist trigger before ovum pick up. This trigger induces short luteinizing hormone (LH) and follicle-stimulating hormone (FSH) peaks, associated with reduced progesterone and estrogen levels during the luteal phase. They cause an inadequate luteal phase and a significantly reduced implantation rate leading to a freeze all practice in those cycles. Study design, size, duration A retrospective cohort study. The study group (n = 123) included women that underwent in vitro fertilization cycles from January 2017 to May 2020. Patients received a GnRH-antagonist with a lone GnRH-agonist trigger due to imminent OSHH. The control group (n = 374) included patients under 35 years old that, during the same time period, underwent a standard antagonist protocol with a dual trigger of a GnRH-agonist and hCG. Participants/materials, setting, methods Study patients were given Dydrogesterone (Duphaston) in addition to micronized progesterone vaginal pills (Utrogestan) for luteal support (Duphaston group). Controls were treated conventionally with Utrogestan for luteal phase support (hCG group). The outcomes measured were pregnancy rate and OHSS events. Main results and the role of chance Our study was the first to evaluate the addition of Duphaston to standard luteal phase support in an antagonist cycle triggered by a lone GnRH agonist before a fresh embryo transfer. The mean number of oocytes retrieved and estradiol plasma levels were significantly higher in the Duphaston group than in the hCG group (16.9 ±7.7 vs. 10.8 ± 5.3 and 11658 ± 5280 pmol/L vs. 6048 ± 3059 pmol/L, respectively). The fertilization rate was comparable between the two groups. The mean number of embryos transferred and the clinical pregnancy rate were also comparable between groups (1.5 ± 0.6 vs 1.5 ± 0.5 and 46.3% vs 40.9%, respectively). No OHSS event was reported in either group. Limitations, reasons for caution This retrospective study may carry an inherent selection and information bias, derived from medical record coding. An additional limitation was the choice of physician for the lone GnRH trigger, which may have introduced a selection bias and another potential caveat was the relatively small sample size of our study groups. Wider implications of the findings: The addition of Duphaston to conventional luteal support could effectively salvage the luteal phase without increasing the risk for OHSS. This enables, to peruse in those cycle, with fresh embryo transfer, avoiding the need to freeze all the embryos and postponed embryo transfer. Leading to lower psychological burden and costs. Trial registration number 0632–20-HMO

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