Impact of Gonadotropin-Releasing Hormone Agonist Pre-treatment on the Cumulative Live Birth Rate in Infertile Women With Adenomyosis Treated With IVF/ICSI: A Retrospective Cohort Study

Minghui Chen; Lu Luo; Qiong Wang; Jun Gao; Yuqing Chen; Yingying Zhang; Canquan Zhou

doi:10.3389/fendo.2020.00318

Impact of Gonadotropin-Releasing Hormone Agonist Pre-treatment on the Cumulative Live Birth Rate in Infertile Women With Adenomyosis Treated With IVF/ICSI: A Retrospective Cohort Study

Front Endocrinol (Lausanne). 2020 May 29:11:318. doi: 10.3389/fendo.2020.00318. eCollection 2020.

Authors

Minghui Chen^{1

2}, Lu Luo^{1

2}, Qiong Wang^{1

2}, Jun Gao^{1

2}, Yuqing Chen³, Yingying Zhang^{1

2}, Canquan Zhou^{1

2}

Affiliations

¹ Reproductive Medicine Center, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
² Guangdong Provincial Key Laboratory of Reproductive Medicine, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
³ Department of Gynecology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.

Abstract

Introduction: Although pre-treatment with a GnRH agonist can reduce the size of adenomyosis lesions, the supra-physiological hormone level induced by controlled ovarian hyperstimulation (COH) may negate the usefulness of the GnRH agonist in patients with adenomyosis lesions, leading to continued poor outcomes in fresh embryo transfer cycles during in vitro fertilization (IVF). It is unclear whether GnRH agonist pre-treatment before starting the long GnRH agonist protocol for IVF/ICSI (intracytoplasmic sperm injection) can improve cumulative live birth rate (CLBR) of infertile women with adenomyosis. Method: In this retrospective cohort study, a total of 374 patients diagnosed as adenomyosis (477 cycles) underwent IVF/ICSI with long GnRH agonist protocol with or without GnRH agonist pre-treatment between January 2009 and June 2018. Logistic regression was used to assess the association between GnRH agonist pre-treatment and pregnancy outcome after adjusting for confounding factors. Results: The live birth rate in fresh embryo transfer cycles was higher in the non-pre-treatment group than in the GnRH agonist pre-treatment group (37.7 vs. 21.2%, P = 0.028); the adjusted odds ratio (OR) for the long agonist protocol without pre-treatment was 1.966 (95% CI: 0.9-4.296, P = 0.09). The CLBR was higher in the non-pre-treatment group than in the GnRH agonist pre-treatment group (40.50 vs. 27.90%, P = 0.019); the adjusted OR for the long agonist protocol without pre-treatment was 1.361 (95% CI: 0.802-2.309, P = 0.254). Conclusion: Our results indicated that GnRH agonist pre-treatment before starting the long GnRH agonist protocol does not improve the live birth rate in fresh embryo transfer cycles or CLBR in infertile women with adenomyosis after IVF/ICSI treatment when compared to that in non-pre-treated patients. A subsequent prospective randomized controlled study is needed to confirm these results.

Keywords: GnRH agonist; adenomyosis; in vitro fertilization; live birth rate; ovarian stimulation.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adenomyosis / complications*
Embryo Transfer
Female
Fertilization in Vitro / methods*
Gonadotropin-Releasing Hormone / agonists*
Humans
Infertility, Female / complications*
Live Birth
Pregnancy
Pregnancy Rate*
Retrospective Studies
Treatment Outcome

Substances

Gonadotropin-Releasing Hormone