The impact of long-term gonadotropin-releasing hormone analogue treatment on preclinical abortions in patients with severe endometriosis undergoing in vitro fertilization-embryo transfer

• Published in: Fertility and sterility Vol. 57; no. 3; pp. 597 - 600
• Main Authors: Dicker, Dov, Goldman, Jack A., Levy, Tally, Feldberg, Dov, Ashkenazi, Jacob
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.03.1992; Elsevier Science
• Subjects: Abortion, Spontaneous; Adult; Biological and medical sciences; Birth control; Delayed-Action Preparations; Embryo Transfer; endometriosis; Endometriosis - drug therapy; Endometriosis - physiopathology; Female; Fertilization in Vitro; gonadotropin-releasing hormone; Gonadotropin-Releasing Hormone - analogs & derivatives; Gonadotropin-Releasing Hormone - therapeutic use; Gynecology. Andrology. Obstetrics; Humans; in vitro fertilization; Medical sciences; Preclinical abortions; Pregnancy; Pregnancy Complications - drug therapy; Pregnancy Complications - physiopathology; Pregnancy Outcome; Sterility. Assisted procreation; Triptorelin Pamoate - analogs & derivatives; endometriosis; in vitro fertilization; gonadotropin-releasing hormone; Preclinical abortions; In vitro fertilization embryo transfer; Human; Prevention; Agonist; Gonadotropin RH; Assisted procreation; Endometriosis; Female; Therapeutic protocol; Abortion; Statistical study; Female genital diseases
• ISSN: 0015-0282; 1556-5653
• DOI: 10.1016/S0015-0282(16)54906-1

To examine the relationship between endometriosis and preclinical abortions and to evaluate the effect of gonadotropin-releasing hormone analogue (GnRH-a) therapy on these pregnancies. Of 67 women with severe endometriosis referred to us for in vitro fertilization-embryo transfer (IVF-ET), 32 underwent ovarian stimulation for oocyte retrieval with menotropins (protocol A), whereas the other 35 were admitted for the procedure after a 6-month period of hormonal suppression with a GnRH agonist (protocol B). The clinical impact of the preclinical and clinical pregnancies in both treatment protocols were evaluated on the basis of oocyte classification and embryo quality score. All patients were treated in our IVF Unit. Clinical pregnancy was used as our main outcome measure of success. A significantly higher number of preclinical pregnancies (P<0.0001) occurred in patients treated by protocol A. After GnRH-a treatment, the preclinical pregnancy rate declined significantly (P<0.0001), whereas the clinical pregnancy rate per cycle and per transfer rose significantly (P<0.0001 and P<0.0001, respectively). Furthermore, clinical pregnancies had a significantly better mean embryo quality score in comparison with preclinical pregnancies (P<0.0001). It is concluded that combining GnRH-a therapy before IVF-ET provides an improved treatment modality for preclinical abortions and infertility associated with severe endometriosis.