Does prolonged pituitary down regulation with gonadotrophin releasing hormone agonist increase live birth rate in in vitro fertilization treatment?

Capsule:
In a comparison of the regular long protocol with a prolonged protocol with 28-days’ down-regulation, a significantly higher live-birth rate (55.56% vs. 45.73%) was observed with the prolonged protocol.

Authors:
Jianzhi Ren, M.D., Aiguo Sha, M.D., Dongmei Han, M.D., Ping Li, M.D., Jie Geng, M.D., Chaihui Ma, M.D.

Volume 102, Issue 1, Pages 75–81

Abstract:

Objective:
To evaluate the effects of a prolonged duration of gonadotropin-releasing hormone agonist (GnRH-a) in pituitary down-regulation for controlled ovarian hyperstimulation (COH) on the live-birth rate in nonendometriotic women undergoing in vitro fertilization and embryo transfer (IVF-ET).

Design:
Retrospective cohort study.

Setting:
University-affiliated hospital.

Patient(s):
Normogonadotropic women undergoing IVF.

Intervention(s):
Three hundred seventy-eight patients receiving a prolonged pituitary down-regulation with GnRH-a before ovarian stimulation and 422 patients receiving a GnRH-a long protocol.

Main Outcome Measure(s):
Live-birth rate per fresh ET.

Result(s):
In comparison with the long protocol, the prolonged down-regulation protocol required a higher total dose of gonadotropins. A lower serum luteinizing hormone (LH) level on the starting day of gonadotropin and the day of human chorionic gonadotropin (hCG) and a fewer number of oocytes and embryos were observed in the prolonged down-regulation protocol. However, the duration of stimulation and number of high-quality embryos were comparable between the two groups. A statistically significantly higher implantation rate (50.27% vs. 39.69%), clinical pregnancy rate (64.02% vs. 56.87%) and live-birth rate per fresh transfer cycle (55.56% vs. 45.73%) were observed in the prolonged protocol.

Conclusion(s):
Prolonged down-regulation in a GnRH-a protocol might increase the live-birth rates in normogonadotropic women.

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