Is the type of gonadotropin-releasing hormone suppression protocol for ovarian hyperstimulation associated with ectopic pregnancy in fresh autologous cycles for in vitro fertilization?
OBJECTIVE
To evaluate the association between different ovarian hyperstimulation protocols and ectopic pregnancy (EP) in in vitro fertilization (IVF) cycles in fresh autologous embryo transfer cycles in the United States between 2008 and 2011 as reported to the Society of Assisted Reproductive Technology (SART).


METHODS
Historical cohort study.


METHODS
Not applicable.


METHODS
None.


METHODS
None.


METHODS
All autologous cycles that resulted in a clinical pregnancy after a fresh, intrauterine embryo transfer and described characteristics of cycles according to protocol were included: luteal GnRH agonist, GnRH agonist flare, or GnRH antagonist. Multivariate logistic regression was conducted to investigate the association between type of protocol and EP.


RESULTS
Among 136,605 clinical pregnancies, 2,645 (1.94%) were EP. Ectopic pregnancy was more frequent with GnRH antagonist (2.4%) cycles than with GnRH agonist flare (2.1%) or luteal GnRH agonist (1.6%) cycles. After adjusting for maternal and treatment characteristics, the GnRH antagonist and the GnRH agonist flare protocols were associated with increased odds of EP (adjusted odds ratio [aOR] 1.52; 95% confidence interval [CI], 1.39-1.65; and aOR 1.25; 95% CI, 1.09-1.44, respectively) compared with luteal GnRH agonist. Analysis of differences in the factors related to EP in luteal GnRH agonist versus GnRH antagonist protocols indicated that diminished ovarian reserve was associated with an increased risk of EP in luteal GnRH agonist but not in GnRH antagonist cycles.


CONCLUSIONS
The type of protocol used during ovarian hyperstimulation in fresh autologous cycles was associated with EP. This finding suggests a role for extrapituitary GnRH on the tubal and uterine environment during ovarian hyperstimulation treatment for IVF.
Department of Gynecology and Obstetrics, Division of Reproductive Endocrinology and Infertility, Johns Hopkins University, Lutherville, Maryland. Electronic address: laura.londra@osumc.edu.
Laura
L
Londra
Department of Population, Family and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.
Caroline
C
Moreau
Department of Population, Family and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.
Donna
D
Strobino
Department of Population, Family and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.
Aarti
A
Bhasin
Department of Gynecology and Obstetrics, Division of Reproductive Endocrinology and Infertility, Johns Hopkins University, Lutherville, Maryland.
Yulian
Y
Zhao
D000328:Adult; D004624:Embryo Transfer / Q000009:adverse effects; D005260:Female; D005298:Fertility; D005299:Fertility Agents / Q000008:administration & dosage / Q000009:adverse effects*; D005307:Fertilization in Vitro / Q000009:adverse effects*; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists / Q000037:antagonists & inhibitors*; D006727:Hormone Antagonists / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D007246:Infertility / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D016015:Logistic Models; D015999:Multivariate Analysis; D016017:Odds Ratio; D010062:Ovulation Induction / Q000009:adverse effects* / Q000379:methods; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000209:etiology*; D012307:Risk Factors; D016896:Treatment Outcome
D005299:Fertility Agents; D006727:Hormone Antagonists; D007987:Gonadotropin-Releasing Hormone
Ectopic pregnancy; IVF; embryo transfer; fresh cycles; ovarian hyperstimulation protocol