Pregnancy outcomes after controlled ovarian hyperstimulation in women with endometriosis-associated infertility: GnRH-agonist versus GnRH-antagonist
Abstract
Background or objective Endometriosis is common in women referred for infertility. In vitro fertilization provides good results but the choice of the best-controlled ovarian hyperstimulation protocol remains a subject of debate. The objective of this retrospective study was to compare pregnancy outcomes in women with endometriosis-associated infertility after COH with a long agonist protocol or a six-week oral contraception-antagonist protocol.Material and methods Retrospective analysis of a prospective database identified 284 COH cycles - 165 with GnRH-agonist protocol (GnRH-agonist group) and 119 with GnRH-antagonist protocol (GnRH-antagonist group) - in 218 women, with endometriosis from January 2013 to October 2015.Results No difference in the epidemiological characteristics was found between the groups. Per started cycle, pregnancy and live-birth rates after fresh embryo transfer were higher with the GnRH-agonist protocol (25% vs. 13%, P=0.02 and 18% vs. 8%, P=0.04, respectively). Considering analysis per cycle with embryo transfer, the pregnancy rate was similar in both groups while the live-birth rate was higher in the GnRH-agonist group (29% vs. 17%, P=0.053 and 22% vs. 10%, P=0.02, respectively). No difference was observed between the groups with freeze-thaw embryo transfer. Subgroup analysis (endometrioma alone, deep infiltrating endometriosis with and without endometrioma, endometriosis with and without adenomyosis) revealed no difference between the groups for either pregnancy or live-birth rates.Conclusion A GnRH-agonist protocol appears to result in higher pregnancy and live-birth rates after fresh embryo transfer in women with endometriosis-associated infertility, suggesting that a GnRH-antagonist protocol might negatively impact endometrial receptivity.
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Embryo transfers conducted in estradiol and progesterone cycles may have a beneficial effect on endometrial receptivity.
“Indeed, embryo transfers conducted in E 2 and progesterone cycles may have a beneficial effect on endometrial receptivity.”
From Endometrial receptivity in adenomyosis and/or endometriosis (2023) · cites this paper as [58]
A few reports suggest GnRH agonist protocols offer higher pregnancy and live birth rates than GnRH antagonist protocols.
“Of note, a few reports, however, suggested that GnRH-a protocols offer higher pregnancy and LBR than those offered by GnRH-antagonist protocols (58,59).”
From Endometrial receptivity in adenomyosis and/or endometriosis (2023) · cites this paper as [58]
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- Authors
- Kolanska, K., Cohen, J., Bendifallah, S., Selleret, L., Antoine, J.-M., Chabbert-Buffet, N., Darai, E., & d’Argent, E.-M.
- Affiliations
- Assistance Publique – Hôpitaux de Paris (FR)
- Corresponding author
- Cohen, J.
- Venue
- Journal of Gynecology Obstetrics and Human Reproduction
- Publisher
- Elsevier BV
- Published
- 2017-11
- Volume
- 46
- Issue
- 9
- Pages
- 681-686
- ISSN
- 2468-7847 (ISSN-L)
- OpenAlex
- W2757880901
- Cited by
- 42
- References
- 34
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 5 · 2023: 8 · 2022: 10 · 2021: 2 · 2020: 4 · 2019: 1 · 2018: 4
- FWCI
- 2.86
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Gynecology Obstetrics and Human Reproduction (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Biology and Fertility
- Health Sciences › Medicine › Reproductive Medicine › Reproductive Health and Technologies
- Keywords
- endometriosis-associated infertility, controlled ovarian stimulation, GnRH agonist protocol, GnRH antagonist protocol, pregnancy rate, live birth rate, fresh embryo transfer, frozen embryo transfer, endometrial receptivity, deep infiltrating endometriosis, endometrioma, adenomyosis
- MeSH terms
- Adult, Endometriosis, Female, Fertility Agents, Female, Fertilization in Vitro, Hormone Antagonists, Humans, Infertility, Gonadotropin-Releasing Hormone, Male, Ovulation Induction, Pregnancy, Pregnancy Outcome, Retrospective Studies, Uterine Diseases, Pregnancy Rate, Sperm Injections, Intracytoplasmic, Young Adult
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