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

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.

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


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).

Retrospective cohort study.

University-affiliated hospital.

Normogonadotropic women undergoing IVF.

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.

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.

Prolonged down-regulation in a GnRH-a protocol might increase the live-birth rates in normogonadotropic women.

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