Top

Archives of Gynecology and Obstetrics

Published in:

01-08-2018 | Gynecologic Endocrinology and Reproductive Medicine

Efficacy of GnRH agonist trigger in women having history of follicular–endometrial asynchrony with clomiphene/IUI cycles in unexplained infertility

Authors: Shikha Bathwal, Astha Chakravarty, Sunita Sharma, Soma Singh, Indranil Saha, Baidyanath Chakravarty

Published in: Archives of Gynecology and Obstetrics | Issue 2/2018

Abstract

Purpose

An alternative option to human chorionic gonadotropin (hCG) is GnRH agonist (GnRH-a) for ovulation trigger in intrauterine insemination (IUI) cycles. This study aims to compare the efficacy of GnRH-a with hCG in women with history of follicular–endometrial asynchrony after clomiphene in IUI cycles.

Methods

This prospective observational study recruited 631 women with unexplained infertility and follicular–endometrial asynchrony (follicle ≥ 18 mm, endometrial thickness (ET) < 7 mm) in previous two failed clomiphene/IUI cycles. Overall 27 patients with synchronized follicular–endometrial relationship and 49 women with persistent ET < 7 mm and/or follicle > 26 mm were excluded. Remaining women (n = 555) were divided into two groups: Group A (n = 285) received GnRH-a and Group B (n = 270) received hCG ovulation trigger. Finally, 513 patients, who underwent IUI, were analysed.

Results

Cancellation due to luteinized unruptured follicle was more in hCG group (P = 0.01). Higher clinical pregnancies (10.33 vs. 4.96%, P = 0.03) and live birth rates (8.86 vs. 4.13%, P = 0.03) were noted with GnRH-a trigger. Miscarriage rate was comparable in both the groups (10.71 and 16.67% in Group A and Group B, respectively).

Conclusion

In unexplained infertility, GnRH agonist is an useful alternative for triggering ovulation in women with follicular–endometrial asynchrony following clomiphene induction.

Mitwally MF, Abdel-Razeq S, Casper RF (2004) Human chorionic gonadotropin administration is associated with high pregnancy rates during ovarian stimulation and timed intercourse or intrauterine insemination. Reprod Biol Endocrinol 2:55–62CrossRefPubMedPubMedCentral

Andersen AG, Als-Nielsen B, Hornnes PJ, Franch Andersen L (1995) Time interval from human chorionic gonadotrophin (HCG) injection to follicular rupture. Hum Reprod 10(12):3202–3205CrossRefPubMed

Farhi J, Orvieto R, Gavish O, Homburg R (2010) The association between follicular size on human chorionic gonadotropin day and pregnancy rate in clomiphene citrate treated polycystic ovary syndrome patients. Gynecol Endocrinol 26:546–548CrossRefPubMed

Qublan H, Amarin Z, Nawasreh M, Diab F, Malkawi S, Al-Ahmad N, Balawneh M (2006) Luteinized unruptured follicle syndrome: incidence and recurrence rate in infertile women with unexplained infertility undergoing intrauterine insemination. Hum Reprod 21(8):2110–2113CrossRefPubMed

Dickey RP, Holtkamp DE (1996) Development, pharmacology and clinical experience with clomiphene citrate. Hum Reprod Update 2:483–506CrossRefPubMed

Nakamura Y, Ono M, Yoshida Y, Sugino N, Ueda K, Kato H (1997) Effects of clomiphene citrate on the endometrial thickness and echogenic pattern of the endometrium. Fertil Steril 67:256–260CrossRefPubMed

Homburg R (2005) Clomifene citrate—end of an era? Hum Reprod 20:2043–2051CrossRefPubMed

Friedler S, Schenken JG, Herman A, Lewin A (1996) The role of ultrasonography in the evaluation of endometrial receptivity following reproductive treatments: a critical review. Hum Reprod Update 4:323–335CrossRef

Dickey RP, Olar TT, Taylor SN, Curole DN, Matulich EM (1993) Relationship of endometrial thickness and pattern to fecundity in ovulation induction cycles; effect of clomiphene citrate alone and with human menopausal gonadotropins. Fertil Steril 59:756–760CrossRefPubMed

10.

Lewis V, Queenan J Jr, Hoeger K, Stevens J, Guzick DS (2006) Clomiphene citrate monitoring for intrauterine insemination timing: a randomized trial. Fertil Steril 85(2):401–406CrossRefPubMed

11.

Humaidan P, Papanikolaou EG, Tarlatzis BC (2009) GnRHa to trigger final oocyte maturation: a time to reconsider. Hum Reprod 24(10):2389–2394CrossRefPubMed

12.

Casper RF (2015) Basic understanding of gonadotropin-releasing hormone–agonist triggering. Fertil Steril 103(4):867–869CrossRefPubMed

13.

Shapiro BS, Andersen CY (2015) Major drawbacks and additional benefits of agonist trigger–not ovarian hyperstimulationsyndrome related. Fertil Steril 103(4):874–878CrossRefPubMed

14.

Youssef MA, Van der Veen F, Al-Inany HG, Mochtar MH, Griesinger G, Nagi Mohesen M, Aboulfoutouh I, van Wely M (2014) Gonadotropin-releasing hormone agonist versus HCG for oocyte triggering in antagonist assisted reproductive technology. Cochrane Database Syst Rev 31(10):CD008046

15.

Gonen Y, Balakier H, Powell W, Casper RF (1990) Use of GnRH agonist to trigger follicular maturation for in vitro fertilization. J Clin Endocrinol Metab 71:918–922CrossRefPubMed

16.

Shalev E, Geslevich Y, Matilsky M, Ben-Ami M (1995) Induction of pre-ovulatory gonadotrophin surge with gonadotrophin-releasing hormone agonist compared to pre-ovulatory injection of human chorionic gonadotrophins for ovulation induction in intrauterine insemination treatment cycles. Hum Reprod 10(9):2244–2247CrossRefPubMed

17.

Scott RT, Bailey SA, Kost ER, Neal GS, Hofmann GE, Illions EH (1994) Comparison of leuprolide acetate and human chorionic gonadotrophin for the induction of ovulation in clomiphene citrate stimulated cycles. Fertil Steril 61(5):872–879CrossRefPubMed

18.

Hutchison JS, Nelson PB, Zeleznik AJ (1986) Effects of different gonadotrophin pulse frequencies on corpus luteum function during the menstrual cycle of rhesus monkeys. Endocrinology 119(5):1964–1971CrossRefPubMed

19.

Cantineau AE, Janssen MJ, Cohlen BJ, Allersma T (2014) Synchronised approach for intrauterine insemination in subfertile couples. Cochrane Database Syst Rev 21(12):CD006942

20.

Lanzone A, Fulghesu AM, Apa R, Caruso A, Mancuso S (1989) LH surge induction by GnRH agonist at the time of ovulation. Gynecol Endocrinol 3(3):213–220CrossRefPubMed

21.

Farag AH, El-deen MHN, Hassan RM (2015) Triggering ovulation with gonadotropin-releasing hormone agonist versus human chorionic gonadotropin in polycystic ovarian syndrome. A randomized trial. Middle East Fertil Soc J 20:217–223CrossRef

22.

Schmidt-Sarosi C, Kaplan DR, Sarosi P, Essig MN, Licciardi FL, Keltz M, Levitz M (1995) Ovulation triggering in clomiphene citrate-stimulated cycles: human chorionic gonadotropin versus a gonadotropin releasing hormone agonist. J Assist Reprod Genet 12(3):167–174CrossRefPubMed

23.

Kucuk T (2008) Intrauterine insemination: is the timing correct? J Assist Reprod Genet 25(8):427–430CrossRefPubMedPubMedCentral

24.

Romeu A, Monzó A, Peiró T, Diez E, Peinado JA, Quintero LA (1997) Endogenous LH surge versus hCG as ovulation trigger after low-dose highly purified FSH in IUI: a comparison of 761 cycles. J Assist Reprod Genet 14(9):518–524CrossRefPubMedPubMedCentral

Title: Efficacy of GnRH agonist trigger in women having history of follicular–endometrial asynchrony with clomiphene/IUI cycles in unexplained infertility
Authors: Shikha Bathwal
Astha Chakravarty
Sunita Sharma
Soma Singh
Indranil Saha
Baidyanath Chakravarty
Publication date: 01-08-2018
Publisher: Springer Berlin Heidelberg
Published in: Archives of Gynecology and Obstetrics / Issue 2/2018
Print ISSN: 0932-0067
Electronic ISSN: 1432-0711
DOI: https://doi.org/10.1007/s00404-018-4834-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Efficacy of GnRH agonist trigger in women having history of follicular–endometrial asynchrony with clomiphene/IUI cycles in unexplained infertility

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 2/2018

Conservative management of endometrial cancer: a survey amongst European clinicians

Study on the cephalopelvic relationship with cephalic presentation in nulliparous full-term Chinese pregnant women by MRI with three-dimensional reconstruction

Temporary intra-arterial balloon occlusion for placenta accreta spectrum disorders: always inflate?

Invasive prenatal diagnosis of α-thalassemia to control Hb Bart’s hydrops fetalis syndrome: 15 years of experience

Reply to the letter to the Editor

Clinical outcomes of frozen embryo versus fresh embryo transfer following in vitro fertilization: a meta-analysis of randomized controlled trials