Effect of GnRH agonist before IVF on outcomes in infertile endometriosis patients: a randomized controlled trial
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.
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Following gonadotropin suppression prior to IVF, women with endometriosis showed reduced follicular testosterone relative to unaffected women.
“Following a period of gonadotropin suppression prior to in vitro fertilization (IVF), women with endometriosis showed reduced follicular testosterone relative to unaffected women (Rodríguez‐Tárrega et al., 2020).”
From Endometriosis and polycystic ovary syndrome are diametric disorders (2021) · cites this paper as Rodríguez‐Tárrega et al., 2020
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- Authors
- Rodríguez-Tárrega, E., Monzo, A. M., Quiroga, R., Polo-Sánchez, P., Fernández-Colom, P., Monterde-Estrada, M., Novella-Maestre, E., & Pellicer, A.
- Affiliations
- Hospital Universitari i Politècnic La Fe (ES)
- Corresponding author
- Rodríguez-Tárrega, Elisabet
- Venue
- Reproductive BioMedicine Online
- Publisher
- Elsevier BV
- Published
- 2020-10
- Volume
- 41
- Issue
- 4
- Pages
- 653-662
- ISSN
- 1472-6483 (ISSN-L)
- OpenAlex
- W3039806799
- Cited by
- 34
- References
- 44
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 11 · 2023: 5 · 2022: 5 · 2021: 6
- FWCI
- 3.53
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Reproductive BioMedicine Online (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Ferring Pharmaceuticals
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
- Health Sciences › Medicine › Reproductive Medicine › Ovarian function and disorders
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Biology and Fertility
- Keywords
- GnRH agonist, endometriosis, in vitro fertilization, infertility, clinical pregnancy rate, ovulation induction, CYP19A1, aromatase gene expression, granulosa cells, cumulus cells, testosterone, estradiol, embryo cleavage, live birth rate
- MeSH terms
- Adult, Androstenedione, Aromatase, Endometriosis, Estradiol, Female, Fertilization in Vitro, Humans, Infertility, Female, Gonadotropin-Releasing Hormone, Luteolytic Agents, Pregnancy, Prospective Studies, Testosterone, Follicular Fluid, Single-Blind Method, Triptorelin Pamoate, Pregnancy Rate
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