title: The addition of gonadotrophin releasing hormone agonist to routine luteal phase support in intracytoplasmic sperm injection and embryo transfer cycles: a randomized clinical trial.
abstract: OBJECTIVE
  To determine the effects of addition of different dosages of gonadotrophin releasing hormone agonist (GnRH-a) to routine luteal phase support (LPS) on implantation and pregnancy rates.
  
  
  METHODS
  Three hundred infertile couples who were treated by intracytoplasmic sperm injection and embryo transfer (ICSI-ET) following controlled ovarian stimulation (COS) with long luteal GnRH agonist protocol were enrolled. All women received 600 mg/day vaginal micronized progesterone plus 4 mg 17β estradiol for LPS starting from the day of oocyte retrieval. Patients (n=300) were randomized into three treatment groups. Group A (n=100) received leuprolide acetate 1 mg s.c. injection 3 days after ET in addition to routine LPS. Group B (n=100) received two sequential doses of leuprolide acetate 1 mg s.c. injections 3 and 6 days after ET in addition to routine LPS. Control group (n=100) received only the routine LPS.
  
  
  RESULTS
  A total of 279 patients completed the study. The groups were comparable in terms of baseline demographic parameters including age, duration of infertility and day 3 levels of FSH and estradiol. The cycle parameters of the groups were also comparable regarding the E2 level on day of hCG, number of retrieved oocytes, number of day 3 embryos, number of embryos transferred, and endometrial thickness on both days of OPU and ET. The implantation rates were similar in between the Groups A, B, and control group (20.7% and 25.8% vs. 13.3%, respectively; P=.099). The clinical pregnancy rates and miscarriage rates were similar in between the groups. The ongoing pregnancy rates were 27.4% in control group, 36% in Group A and 42.9% in Group B (P=.093). The OHSS rates were comparable in between the groups. The multiple pregnancy rates were significantly higher in Groups A and B than in control group (12% and 17.9% vs. 4.2%, respectively; P=.014).
  
  
  CONCLUSIONS
  The implantation, clinical pregnancy and ongoing pregnancy and multiple pregnancy rates seem to be increased with the addition of GnRH-a to routine luteal phase support.
authors.affiliation: Ankara University School of Medicine, Department of Obstetrics and Gynecology, Ankara, Turkey. Electronic address: gulsahayna@gmail.com.
authors.forename: Gülşah Aynaoğlu
authors.initials: GA
authors.lastname: Yıldız
authors.affiliation: Ankara University School of Medicine, Department of Obstetrics and Gynecology, Ankara, Turkey.
authors.forename: Yavuz Emre
authors.initials: YE
authors.lastname: Şükür
authors.affiliation: Ankara University School of Medicine, Department of Biostatistics, Ankara, Turkey.
authors.forename: Can
authors.initials: C
authors.lastname: Ateş
authors.affiliation: Ankara University School of Medicine, Department of Obstetrics and Gynecology, Ankara, Turkey.
authors.forename: Ruşen
authors.initials: R
authors.lastname: Aytaç
mesh_terms: D000022:Abortion, Spontaneous / Q000209:etiology; D000328:Adult; D010064:Embryo Implantation / Q000187:drug effects; D004624:Embryo Transfer; D004958:Estradiol / Q000627:therapeutic use; D005260:Female; D005300:Fertility Agents, Female / Q000008:administration & dosage*; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists*; D006801:Humans; D016729:Leuprolide / Q000008:administration & dosage*; D008183:Luteal Phase; D016471:Ovarian Hyperstimulation Syndrome / Q000139:chemically induced; D010062:Ovulation Induction / Q000379:methods*; D011247:Pregnancy; D018873:Pregnancy Rate; D011272:Pregnancy, Multiple / Q000187:drug effects; D011374:Progesterone / Q000627:therapeutic use; D011446:Prospective Studies; D020554:Sperm Injections, Intracytoplasmic; D055815:Young Adult
chemical_list: D005300:Fertility Agents, Female; D007987:Gonadotropin-Releasing Hormone; D011374:Progesterone; D004958:Estradiol; D016729:Leuprolide
keywords: Clinical pregnancy rate; GnRH agonist; Implantation rate; Intracytoplasmic sperm injection; Luteal phase support