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publication name Is Late Preparation with Gonadotropin-releasing Hormone (GnRh) Agonist Injection on Day-1 of Hormonal Replacement Cycle improves pregnancy rate after Frozen-thawed Embryo Transfer?
Authors Hesham M. Abo Ragab MD, Ayman A. Shedid MD
year 2018
keywords PCOS infertility, GnRH agonist, Time of injection, Clinical pregnancy rate
journal
volume Not Available
issue Not Available
pages Not Available
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Local/International International
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Abstract

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.

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