Does the type of GnRH analogue used, affect live birth rates in women with endometriosis undergoing IVF/ICSI treatment, according to the rAFS stage?

Abstract

Since the introduction of gonadotropin-releasing hormone (GnRH) antagonists, an extensive amount of literature investigating the role of the downregulation protocols on pregnancy outcomes has been published. However, these studies were mainly performed in the general infertile population where patients with endometriosis were often excluded or underrepresented. This study is a large retrospective cohort study including 386 endometriosis patients undergoing IVF/ICSI, who had been previously classified according to the rAFS system. Patients were stimulated either a long GnRH agonist or GnRH antagonist protocol. Depending on endometriosis stage, patients were divided into two groups: endometriosis stage I–II and endometriosis stage III–IV. Each group was subdivided, based on the type GnRH analog used. When comparing the GnRH agonist and antagonist groups, patients with endometriosis stage I–II, had a tendency toward higher β-hCG positive, clinical pregnancy, and live birth rates (42.8% vs. 26.7%; p = .07) in favor of GnRH agonist use. In endometriosis stage III–IV, no differences were observed between agonist and antagonist cycle in any of the pregnancy outcomes. Multivariate regression analysis did not reveal any significant predictor of live birth after adjusting for relevant confounders. Based on our findings, the chance to have a liveborn in endometriosis population seems not to be affected by the type of GnRH analog used, at least in advanced stages. Findings from stage I–II endometriosis cases merit consideration and further evaluation in a larger sample size is warranted.

Chinese abstract

自引入促性腺激素释放激素（GnRH）拮抗剂以来, 截至目前已发表了大量关于下调方案对妊娠结局的作用的文献。然而, 这些研究主要在普通不育人群中进行, 而子宫内膜异位症患者经常被排除或数量不足。本研究是一项大型回顾性队列研究, 包括386名接受IVF/ICSI的子宫内膜异位症患者, 这些患者之前已根据rAFS评分系统进行了分期。患者的卵泡刺激方案为GnRH激动剂或GnRH拮抗剂的长方案。当比较GnRH激动剂和拮抗剂组时, 子宫内膜异位症I-II期患者用GnRH 激动剂治疗者, 有更高的b-hCG阳性率、临床妊娠率和活产率（42.8％比26.7％; p = 0.07）。而子宫内膜异位症III-IV期患者, 激动剂和拮抗剂组间无妊娠结局差异。在调整相关混杂因素后, 多变量回归分析未显示任何显著的活产预测因子。根据本研究结果, 子宫内膜异位症患者中活产率似乎不受所用的GnRH类似物类型的影响, 至少在内膜异位症晚期患者中结果如此。而来自I-II期子宫内膜异位症患者的结果值得考量, 并且需要在更大的样本量中进一步评估。

Keywords:

• Endometriosis
• GnRH agonist
• GnRH antagonist
• ovarian stimulation

Disclosure statement

No potential conflict of interest was reported by the authors.