title: Repeated doses of GnRH antagonist at midcycle in artificial frozen embryo transfer cycles may not affect pregnancy outcomes.
abstract: No significant differences in outcomes have been found between protocols of endometrial preparation for frozen embryo transfer (FET), though gonadotropin releasing hormone (GnRH) antagonists may have detrimental effects on the endometrium. We conducted a retrospective cohort noninferiority study at a single academic center of women receiving multiple doses of mid-cycle GnRH antagonist (GAnt) to those receiving GnRH agonist (GAg) to determine if there are detrimental effects of GnRH antagonists. 1047 FET cycles were identified, detailed data was available in 840 cycles: 610 GAg and 230 GAnt cycles. Patients undergoing GAnt cycles were older (40 ± 6.6 versus 37 ± 5.1 years, p < 0.0001), more often used donor oocyte (36% versus 18.6%, p < 0.0001), and more often exhibited diminished ovarian reserve (49.1% versus 36.2%, p = 0.0009). Clinical pregnancy rates (CPRs) per transfer and implantation rates (IRs) were similar for GAnt and GAg cycles. There was a trend for higher pregnancy and IRs with GAg cycles in younger women (CPR 38.8% versus 26.7%, p = 0.16; IR 36% versus 23.3%, p = 0.07). Stratifying by diagnosis, CPR and IR were similar in GAnt and GAg cycles. A GAnt protocol of endometrial preparation for FET is not inferior to a GAg protocol regardless of patient age, use of donor oocyte, or infertility diagnosis.
authors.affiliation: a Department of Obstetrics and Gynecology , Division of Reproductive Endocrinology and Infertility and.
authors.forename: Katherine L
authors.initials: KL
authors.lastname: Palmerola
authors.affiliation: b Department of Obstetrics and Gynecology , Columbia University College of Physicians and Surgeons , New York , NY , USA.
authors.forename: Jennifer Y
authors.initials: JY
authors.lastname: Hsu
authors.affiliation: a Department of Obstetrics and Gynecology , Division of Reproductive Endocrinology and Infertility and.
authors.forename: Lisa C
authors.initials: LC
authors.lastname: Grossman
authors.affiliation: a Department of Obstetrics and Gynecology , Division of Reproductive Endocrinology and Infertility and.
authors.forename: Mark V
authors.initials: MV
authors.lastname: Sauer
authors.affiliation: a Department of Obstetrics and Gynecology , Division of Reproductive Endocrinology and Infertility and.
authors.forename: Roger A
authors.initials: RA
authors.lastname: Lobo
mesh_terms: D000328:Adult; D004624:Embryo Transfer / Q000379:methods*; D004958:Estradiol / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000097:blood / Q000627:therapeutic use; D005260:Female; D005300:Fertility Agents, Female / Q000008:administration & dosage / Q000627:therapeutic use*; D005307:Fertilization in Vitro / Q000379:methods; D007987:Gonadotropin-Releasing Hormone / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000037:antagonists & inhibitors* / Q000627:therapeutic use; D006727:Hormone Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D016729:Leuprolide / Q000008:administration & dosage / Q000627:therapeutic use*; D010062:Ovulation Induction / Q000379:methods; D011247:Pregnancy; D011256:Pregnancy Outcome; D018873:Pregnancy Rate; D012189:Retrospective Studies
chemical_list: D005300:Fertility Agents, Female; D006727:Hormone Antagonists; D007987:Gonadotropin-Releasing Hormone; D004958:Estradiol; D016729:Leuprolide; C061018:ganirelix
keywords: Endometrial preparation; GnRH agonist; GnRH antagonist; frozen embryo transfer; pregnancy outcome