Administration of single-dose GnRH agonist in the luteal phase in ICSI cycles: a meta-analysis.
BACKGROUND
The effects of gonadotrophin-releasing hormone agonist (GnRH-a) administered in the luteal phase remains controversial. This meta-analysis aimed to evaluate the effect of the administration of a single-dose of GnRH-a in the luteal phase on ICSI clinical outcomes.


METHODS
The research strategy included the online search of databases. Only randomized studies were included. The outcomes analyzed were implantation rate, clinical pregnancy rate (CPR) per transfer and ongoing pregnancy rate. The fixed effects model was used for odds ratio. In all trials, a single dose of GnRH-a was administered at day 5/6 after ICSI procedures.


RESULTS
All cycles presented statistically significantly higher rates of implantation (P<0.0001), CPR per transfer (P=0.006) and ongoing pregnancy (P=0.02) in the group that received luteal-phase GnRH-a administration than in the control group (without luteal-phase-GnRH-a administration). When meta-analysis was carried out only in trials that had used long GnRH-a ovarian stimulation protocol, CPR per transfer (P=0.06) and ongoing pregnancy (P=0.23) rates were not significantly different between the groups, but implantation rate was significant higher (P=0.02) in the group that received luteal-phase-GnRH-a administration. On the other hand, the results from trials that had used GnRH antagonist multi-dose ovarian stimulation protocol showed statistically significantly higher implantation (P=0.0002), CPR per transfer (P=0.04) and ongoing pregnancy rate (P=0.04) in the luteal-phase-GnRH-a administration group. The majority of the results presented heterogeneity.


CONCLUSIONS
These findings demonstrate that the luteal-phase single-dose GnRH-a administration can increase implantation rate in all cycles and CPR per transfer and ongoing pregnancy rate in cycles with GnRH antagonist ovarian stimulation protocol. Nevertheless, by considering the heterogeneity between the trials, it seems premature to recommend the use of GnRH-a in the luteal phase. Additional randomized controlled trials are necessary before evidence-based recommendations can be provided.
Oliveira
João Batista A
JB
Department of Gynecology and Obstetrics, Botucatu Medical School São Paulo State University-UNESP Sao Paulo, Brazil. joaobatista@crh.com.br
Baruffi
Ricardo
R
Petersen
Cláudia G
CG
Mauri
Ana L
AL
Cavagna
Mario
M
Franco
José G
JG
D000465:Algorithms; D004305:Dose-Response Relationship, Drug; D005260:Female; D005300:Fertility Agents, Female / Q000008:administration & dosage*; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists*; D006801:Humans; D007246:Infertility / Q000628:therapy*; D008183:Luteal Phase / Q000187:drug effects*; D010062:Ovulation Induction / Q000379:methods; D011247:Pregnancy; D018873:Pregnancy Rate; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D020554:Sperm Injections, Intracytoplasmic / Q000706:statistics & numerical data; D016896:Treatment Outcome; D017329:Triptorelin Pamoate / Q000008:administration & dosage / Q000031:analogs & derivatives
D005300:Fertility Agents, Female; D017329:Triptorelin Pamoate; D007987:Gonadotropin-Releasing Hormone; C066438:deslorelin
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