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Background: Successful outcome with frozen-thawed human embryo transfer has made embryo cryopreservation a routine procedure in assisted reproductive technology (ART). Evidence did not support the use of one cycle regimen in preference to another in frozen-thawed embryo transfer (FET) preparation of infertile women with regular ovulatory cycles.
Objective: To analyse whether down-regulation with a gonadotropin-releasing hormone agonist (GnRHa) has any effect on clinical outcomes of FET cycles using oestrogen (E2) and proges-terone (P4) sequentially for the artificial preparation of the endometrium.
Materials and methods: A retrospective analysis was done on 100 women (50 in each group) who underwent FET cycle from December 2018 to August 2019 at Ridge IVF centre, Gouri Hospital and Fortis hospital, Shalimar Bagh, Delhi. Inclusion criteria were women who have undergone all consecutive cycles with the same protocol (either with or without GnRH agonist). Donor oocyte and cross-over cycles were excluded. In GnRH-downregulated cycles (group A-53 cycles) Leuprolide acetate (Leuprodex depot 3.75 mg) was given intramuscularly on day 2 of the menses and the patients were called after 3 weeks of injection and the endometrium was prepared artificially using combination of oestrogen (E2) and progesterone (P4). In GnRH non-downregulated group (group B-55 cycles), artificial preparation began on days 1—of the cycle. Cryopreserved embryos (day 3 or day 5) were transferred (4 days and 6 days) after initiation of progesterone therapy respectively and clinical outcomes were compared.
Results: Both the groups were similar in terms of baseline characteristics like age, BMI, duration, type and cause of infertility, number of embryos cryopreserved, thawed and, transferred and endometrial thickness on the day of beginning progesterone therapy. There was difference of 7% in the rate of implantation (67% versus 60.0%), 13.6% in the clinical pregnancy rate (59.6% versus 46%), and 13.7% in ongoing pregnancy rate (57.7% versus 44%) in group A versus group B respectively, although the difference was not statistically significant (p value >0.05). The cycle cancellation rate was also higher in group B 9% as compared to 1.9% in group A but it was not statistically significant (p-0.11).
Conclusion: Although, hormone therapy FET with GnRHa down regulation group reported better clinical outcomes, the difference was not statistically significant when compared with hormone therapy FET without GnRHa.
Keywords: Hormonal therapy; Frozen thawed embryo transfer