Impact of final oocyte maturation using gonadotropin releasing hormone agonist triggering and different luteal support protocols on endometrial gene expression

Capsule:
Genes related to endometrial receptivity were analyzed on 25 endometrial samples after GnRH-a triggering and different luteal support protocols; adding LH/hCG activity more closely resembles the expression after hCG triggering.

Authors:
Alfonso Bermejo, M.D., María Cerrillo, M.D., María Ruiz-Alonso, David Blesa, Ph.D., Carlos Simón, M.D., Ph.D., Antonio Pellicer, M.D., Ph.D., Juan A. Garcia-Velasco, M.D., Ph.D.

Volume 101, Issue 1, Pages 138-146.e3, January 2014

Abstract:

Objective:
To use microarray technology to analyze endometrial gene expression after gonadotropin-releasing hormone agonist (GnRH-a) triggering with four different protocols of luteal support in comparison with results obtained after a human chorionic gonadotropin (hCG) trigger.

Design:
Prospective, randomized, controlled trial.

Setting:
University-affiliated private assisted-reproduction center.

Patient(s):
25 healthy oocyte donors undergoing controlled ovarian stimulation.

Intervention(s):
On day of final oocyte maturation, randomization to [1] GnRH-agonist triggering and luteal support with oral estradiol (2 mg/8 hours) and vaginal progesterone (200 mg/12 hours), [2] GnRH-a and a daily dose of 150 IU of recombinant LH from oocyte pickup, [3] GnRH-a and a single bolus of 60 μg of recombinant hCG on oocyte pickup, [4] GnRH-a and three doses of 20 μg of recombinant hCG separated by 48 hours, or [5] 250 μg of recombinant hCG for trigger and standard luteal support; with endometrial biopsy samples collected 7 days after triggering.

Main Outcome Measure(s):
Gene expression using the Endometrial Receptivity Array (ERA) and pathway and network analysis of study groups 1–4 compared with controls (group 5).

Result(s):
The 56 genes in group 1 (25 up-regulated and 31 down-regulated) exhibited altered expression compared with the 36 genes from group 2 (13 up-regulated and 23 down-regulated), 44 from group 3 (28 up-regulated and 16 down-regulated), and 30 (20 up-regulated and 10 down-regulated) from group 4.

Conclusion(s):
Differences were seen in endometrial gene expression related to the type of ovulation trigger and luteal support. However, gene expression after the GnRH-a trigger and modified luteal support adding LH/hCG activity more closely resembles the pattern seen in the hCG group.

Clinical Trial Registration Number:
EudraCT 2011-003250-34.

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