Effect of GnRH agonist before IVF on outcomes in infertile endometriosis patients: a randomized controlled trial

Fecha de publicación: 01/10/2020 Fecha Ahead of Print: 05/07/2020

Autores de IIS La Fe

Elisabet Rodriguez Tarrega

Autor
Ana María Monzó Miralles

Autor
Ramiro De La Cruz Quiroga

Autor
Patrocinio Polo Sanchez

Autor
Pedro José Fernández Colom

Autor
Mercedes Monterde Estrada

Autor
Edurne Novella Maestre

Autor
Antonio Pellicer Martínez

Autor

Grupos

Medicina Reproductiva

Investigador Principal

José Morales Roselló

Abstract

Research question: Does 3-months of gonadotrophin releasing hormone agonist (GnRHa) treatment before IVF improve clinical pregnancy rate in infertile patients with endometriosis? Design: Single-blind, placebo-controlled clinical trial of 200 infertile women with endometriosis assigned to use GnRHa (study group) or placebo (control group) for 3 months before IVF. Clinical, embryological outcomes and stimulation parameters were analysed. Clinical pregnancy rate was the primary endpoint. In a subgroup of 40 patients, follicular fluid levels of oestradiol, testosterone and androstendione were measured. Gene expression profile of CYP19A1 was analysed in cumulus and mural granulosa cells. Results: Implantation or clinical pregnancy rate were not significantly different between the two groups. Clinical pregnancy rates were 25.3% and 33.7% in the study and control groups, respectively (P = 0.212). Cumulative live birth rate was not significantly different: 22.0% (95% CI 13.0 to 31.0) in the study group and 33.7% (95% CI 24.0 to 44.0) in the control group (P = 0.077). Ovarian stimulation was significantly longer and total dose of gonadotrophins significantly higher in the study group (both P < 0.001). Serum oestradiol levels on the day of HCG were significantly lower in the study group (P = 0.001). Cancellation rate was significantly higher in the study group (P = 0.042), whereas cleavage embryos were significantly more numerous in the control group (P = 0.023). No significant differences in the expression of CYP19A1 gene in mural or cumulus granulosa cells or steroid levels in follicular fluid between the two groups were observed, but testosterone was significantly lower in the study group (P < 0.001). Conclusion: Three-months of GnRHa treatment before IVF does not improve clinical pregnancy rate in women with endometriosis.

Datos de la publicación

ISSN/ISSNe:: 1472-6483, 1472-6491
Tipo:: Article
Páginas:: 653-662
DOI:: 10.1016/j.rbmo.2020.06.020
PubMed:: 32782170
Factor de Impacto:: 1,208 SCImago ℠
Cuartil:: Q1 SCImago ℠

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Filiaciones

Rodriguez-Tarrega, E:: Univ Hosp La Fe, Human Reprod Unit, Ave Fernando Abril Martorell 106, Valencia 46026, Spain
Monzo, AM:: Univ Hosp La Fe, Human Reprod Unit, Ave Fernando Abril Martorell 106, Valencia 46026, Spain

Instituto de Investigación. Univ Hosp La Fe, Reprod Med Res Grp, Inst Invest Sanitaria La Fe, Ave Fernando Abril Martorell 106, Valencia 46026, Spain
Quiroga, R:: Univ Hosp La Fe, Human Reprod Unit, Ave Fernando Abril Martorell 106, Valencia 46026, Spain
Polo-Sanchez, P:: Univ Hosp La Fe, Human Reprod Unit, Ave Fernando Abril Martorell 106, Valencia 46026, Spain
Fernandez-Colom, P:: Univ Hosp La Fe, Human Reprod Unit, Ave Fernando Abril Martorell 106, Valencia 46026, Spain
Monterde-Estrada, M:: Univ Hosp La Fe, Human Reprod Unit, Ave Fernando Abril Martorell 106, Valencia 46026, Spain
Novella-Maestre, E:: Univ Hosp La Fe, Genet Unit, Ave Fernando Abril Martorell 106, Valencia 46026, Spain

Instituto de Investigación. Univ Hosp La Fe, Reprod Med Res Grp, Inst Invest Sanitaria La Fe, Ave Fernando Abril Martorell 106, Valencia 46026, Spain
Pellicer, A:: Instituto de Investigación. Univ Hosp La Fe, Reprod Med Res Grp, Inst Invest Sanitaria La Fe, Ave Fernando Abril Martorell 106, Valencia 46026, Spain

IVI Rome, I-00197 Rome, Italy