The routine use of gonadotropin-releasing hormone agonists prior to in vitro fertilization and gamete intrafallopian transfer: a meta-analysis of randomized controlled trials

• Published in: Fertility and sterility Vol. 58; no. 5; pp. 888 - 896
• Main Authors: Hughes, Edward G., Fedorkow, Donna M., Daya, Salim, Sagle, Margaret A., Van de Koppel, Patrick, Collins, John A.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.11.1992; Elsevier Science
• Subjects: Abortion, Spontaneous - epidemiology; Biological and medical sciences; Embryo Implantation; Female; Fertilization in Vitro; Gamete Intrafallopian Transfer; Genital system. Reproduction; Gonadotropin-Releasing Hormone - administration & dosage; Gonadotropin-Releasing Hormone - analogs & derivatives; Gonadotropin-Releasing Hormone - therapeutic use; Gonadotropin-releasing hormone agonist; Humans; in vitro fertilization; Medical sciences; meta-analysis; Oocytes - physiology; Ovarian Hyperstimulation Syndrome - epidemiology; Pharmacology. Drug treatments; Pregnancy; Pregnancy, Multiple; in vitro fertilization; meta-analysis; gamete intrafallopian transfer; Gonadotropin-releasing hormone agonist; Human; Agonist; Chemotherapy; Treatment; Gonadotropin RH; Gamete intrafallopian transfer; Fecundation; Statistical study; In vitro
• ISSN: 0015-0282; 1556-5653
• DOI: 10.1016/S0015-0282(16)55430-2

To assess the efficacy of gonadotropin-releasing hormone agonists (GnRH-a) used in ovulation induction for in vitro fertilization and embryo transfer (IVF-ET) and gamete intrafallopian transfer (GIFT). Meta-analysis of 10 trials comparing treatment cycle outcomes after GnRH-a (n=914) with other ovulation induction protocols (n=722) and 7 trials comparing outcomes after short flare-up (n=368) with longer suppression (n=476) GnRH-a protocols. The outcome of primary interest was clinical pregnancy rate (PR) per treatment cycle commenced. Data describing the amount of gonadotropin used, cycle cancellation rate, clinical pregnancy per ET, and multiple pregnancy and abortion rates were also analyzed. Clinical PR per cycle commenced was significantly improved after GnRH-a use for IVF (common odds ratio [OR] 1.80, 95% confidence interval [CI] 1.33 to 2.44) and GIFT (common OR 2.37, 95% CI 1.24 to 4.51). Clinical PR per embryo transfer was also significantly improved with GnRH-a use (common OR 1.40, 95% CI 1.01 to 1.95). Cycle cancellation was decreased (common OR 0.33, 95% CI 0.25 to 0.44), whereas spontaneous abortion rate was similar with and without GnRH-a use. Cycle cancellation and PRs after short flare-up and longer suppression protocols were similar between groups. This meta-analysis supports the routine use of GnRH-a for IVF and GIFT. Further research is needed, however, to assess the potential for increased rates of multiple pregnancy and ovarian hyperstimulation syndrome, which may be associated with this treatment.