Objectives: To evaluate effect of changing time of gonadotropin-releasing hormone agonist (GnRH-a) injection on outcome of infertile women with polycystic ovary syndrome (PCOS) and scheduled for HRT frozen embryo transfer (HRT-FET) cycles.
Patients & Methods: Out of PCOS women who underwent ICSI and embryo cryopreservation, to guard against ovarian hyperstimulation syndrome, 164 women underwent HRT-FET. These women were randomly divided according to timing of GnRH-a triptoreline (Decapeptyl depot; 3.75 mg) subcutaneous injection into Control received injection on day-21 of menstrual cycle preceding ET cycle or Study women received injection of day-1 of menses of ET cycle. All women received estradiol valerate (2 mg/day) on day-2 of menses of ET cycle with incremental increase till endometrial thickness was 8 mm. Intravaginal progesterone was given for 2-days before ET and continued thereafter. Chemical pregnancy was diagnosed 14 day after ET and clinical pregnancy was assured by TVU 2-weeks later. In case of pregnancy, progesterone was continued till week 10. Study outcomes included the clinical pregnancy rate (CPR) and the 12-wk pregnancy loss rate.
Results: Collectively, 90 women got pregnant for a CPR of 54.9% per woman; 35 control and 55 study women for CPR of 42.7% versus 67.1% per woman with a significantly higher CPR per woman (p=0.00013) in study group. The 12-wk pregnancy loss rate was non-significantly (p=0.647) higher among control women. The frequency of women completed their 12-wk follow-up without actual or threatened abortion was significantly (p=0.005) higher in study group.
Conclusion: Injecting depot GnRH-a with HRT is appropriate protocol for FET in infertile PCOS women with irregular menstruation, giving collective CPR of 54.9%. Injection of depot GnRH-a on day-1 of menses of transfer cycle improved outcome and increased the CPR by >50% than injection on day-21 of previous menses.