Contribution to More Patient-Friendly ART Treatment: Efficacy of Continuous Low-Dose GnRH Agonist as the Only Luteal Support-Results of a Prospective, Randomized, Comparative Study

Céline Pirard, Ernest Loumaye, Pascale Laurent, Christine Wyns, Céline Pirard, Ernest Loumaye, Pascale Laurent, Christine Wyns

Abstract

Background. The aim of this pilot study was to evaluate intranasal buserelin for luteal phase support and compare its efficacy with standard vaginal progesterone in IVF/ICSI antagonist cycles. Methods. This is a prospective, randomized, open, parallel group study. Forty patients underwent ovarian hyperstimulation with human menopausal gonadotropin under pituitary inhibition with gonadotropin-releasing hormone antagonist, while ovulation trigger and luteal support were achieved using intranasal GnRH agonist (group A). Twenty patients had their cycle downregulated with buserelin and stimulated with hMG, while ovulation trigger was achieved using 10,000 IU human chorionic gonadotropin with luteal support by intravaginal progesterone (group B). Results. No difference was observed in estradiol levels. Progesterone levels on day 5 were significantly lower in group A. However, significantly higher levels of luteinizing hormone were observed in group A during the entire luteal phase. Pregnancy rates (31.4% versus 22.2%), implantation rates (22% versus 15.4%), and clinical pregnancy rates (25.7% versus 16.7%) were not statistically different between groups, although a trend towards higher rates was observed in group A. No luteal phase lasting less than 10 days was recorded in either group. Conclusion. Intranasal administration of buserelin is effective for providing luteal phase support in IVF/ICSI antagonist protocols.

Figures

Figure 1
Figure 1
Randomization and allocation of patients to the two groups. In group A, ovulation was triggered with buserelin and the luteal phase was also supported by buserelin. In group B, ovulation was triggered with hCG and the luteal phase was supported with vaginal micronized progesterone.
Figure 2
Figure 2
Hormone levels during the luteal phase on D0 (day of ovulation trigger), D2, D5, D9, and D14. (a) Mean progesterone levels. (b) Mean estradiol levels. (c) Mean LH levels.

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