Effect Of Prolonged Gonadotropin-releasing Hormone Agonist Protocol On The Outcome Of Assisted Reproductive Technology In Patients With Endometriosis Associated Infertility

OBJECTIVE:With the increasing incidence of endometriosis,endometriosis associated infertility has become an important clinical issue.Severe endometriosis is associated with pelvic adhesions and a distortion ofpelvic anatomy leading to a possible mechanic or anatomic disturbance ofinfertility. However,it is possible that endometriosis, even in a mild stage,may have a direct negative effect on women' fertile ability because theimmune and inflammatory abnormality. In vitro fertilization offers thehighest pregnancy rates of assisted reproductive technologies and is oftenused to treat women with infertility associated with endometriosis. Thequestion of whether the presence of endometriosis affects the outcome ofART has not been resolved, but the outcome in those patients is usually notsatisfied. Gonadotropin-releasing hormone agonist (GnRHa) is an effectivedrug used in treating endometriosis now., and the benefit of downregulationwith it is sure. But the most effective dose has not been decided. To thosepatients, what COH (controlled ovarian hyperstimulation) regimen is better,prolonged protocol or long protocol ? The answer is meaningful inimproving the ART outcome of those patients. We design this study toevaluate the effect of a 2 or 3 month course of GnRHa administeredimmediately before IVF-ET or ICSI in infertile patients with endometriosis. MATERIALS AND METHODS:In a retrospective study , all 54endometriosis patients (58 cycles) during 200.1 ~ 2005.3 were analyzedand they were divided into two groups:group A (17 cycles) with prolongedGnRHa protocol and group B (41 cycles) with long protocol. Group A has11 primary infertility patients and Group B has 29. There are no significantdifferents on age,years of infertility,basic E2 and basic FSH in the twogroups. The two groups were compared in indicates of clinical andlaboratory, the rate of implantation and pregnancy. RESULTS:There were no statistically significant differences betweenthe two groups in dose of Gn administered,oocytes obtained,number of 1and 2 grade embryo,GS number and embryo transfer number. But therewere significant differences in FSH dose ,endocrine indicates of HCGinjection day and fertility rate. Group A has low LH and E2 on the dayinjection HCG, and fertility rate in this group is significantly high. Theclinical pregnancy rate per cycle in this prolonged protocol group is52.94%. Athough there is no statistical difference, it is meaningful in termsof the small sample number. CONCLUSIONS: The patients with endometriosis associatedinfertility have a tendency of poor ART outcome compared with our otherfactor infertility patients, because the total pregnancy rate in high in ourinstitute. The Gn dose would not notablely increase and no poor ovarianresponse has been observed after 2 or 3 month course of GnRHaadministered immediately before IVF-ET or ICSI. Given the high rate offertility,implantation and pregnancy, though some has no statisticallydifferences, prolonged GnRHa protocol is beneficial to endometriosispatients.