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The addition of GNRH agonist for luteal phase support in ovum donation cycles
Summary of the main findings.
Ongoing pregnancy Clinical pregnancy Miscarriage Dissatisfaction Ongoing pregnancy Clinical pregnancy Miscarriage Dissatisfaction
Vaginal progesterone capsules
Oral dydrogesterone
RR (95% CI)
Participants / Studies
Authors’ Interpretation
20% 27% 23% 26% Vaginal progesterone gel 27% 31% 11% 18%
25% (21-31%) 34% (30-39%) 17% (11-26%) 3% (1-10%) Oral dydrogesterone 27% (23-31%) 29% (25-34%) 9% (5-15%) 5% (3-8%)
1.24 (1.02-1.51) 1.24 (1.08-1.41) 0.75 (0.49-1.14) 0.10 (0.02-0.39)
1,611 / 5 2,286 / 6 438 / 5 430 / 1
Dydrogesterone is better Dydrogesterone is better No evidence of difference Dydrogesterone is better
Moderate Moderate Low High
0.97 (0.83-1.13) 0.95 (0.82-1.09) 0.81 (0.48-1.35) 0.26 (0.16-0.42)
1,735 / 2 1,735 / 2 523 / 2 822 / 1
No relevant difference No relevant difference No evidence of difference Dydrogesterone is better
High High Low High
OBJECTIVE: To identify, appraise and summarize the evidence from randomized controlled trials (RCTs) comparing oral dydrogesterone with progesterone for luteal-phase support (LPS) in women undergoing IVF/ICSI. DESIGN: Systematic review and meta-analysis. MATERIALS AND METHODS: Record screening, study selection, data extraction, and evaluation of the risk of bias were performed independently by two authors. The comparison between dydrogesterone and progesterone were summarized as risk ratio (RR) and the precision of the estimates was assessed by the 95% confidence interval (CI). RESULTS: Our electronic search was performed in Mar-17-2015 and 7 studies were included in our quantitative analysis: 5 studies compared oral dydrogesterone with vaginal progesterone capsules; 1 study compared oral dydrogesterone with vaginal progesterone gel; and 1 study has three arms: oral dydrogesterone, vaginal progesterone capsules and vaginal progesterone gel, being considered in both comparisons. We didn’t find any study comparing oral dydrogesterone with intramuscular or oral progesterone. The main results are reported in the table. CONCLUSIONS: The available evidence from RCTs suggests that oral dydrogesterone for LPS provides at least similar reproductive outcomes and less dissatisfaction than vaginal progesterone capsules or gel. Supported by: Conselho Nacional de Desenvolvimento Cientıfico e Tecnol ogico (CNPq); S~ao Paulo Research Foundation (FAPESP). P-698 Wednesday, October 21, 2015 THE ADDITION OF GNRH AGONIST FOR LUTEAL PHASE SUPPORT IN OVUM DONATION CYCLES. P. Casanova,a E. Szlit Feldman,b G. J. Rey Valzacchi,b L. A. Blanco,c C. A. Carrere,b A. Torno,d M. A. Rodriguez Kubrusli,a J. I. Mannara,d V. E. Canada.e aGynecologist Procrearte, Buenos Aires, Argentina; bProcrearte Director, Buenos Aires, Argentina; cReproductive Medicine, Caba, Argentina; dProcrearte, Buenos Aires, Argentina; eProcrearte, Capital Federal, Argentina. OBJECTIVE: To evaluate the effect of 0,1mg triptorelin in a single injection administered to ovum donation recipients the 6th day after donor oocyte retrieval on pregnancy outcomes. DESIGN: Prospective trial. MATERIALS AND METHODS: This study involved 78 ovum donation cycles between August 2014 and February 2015, in a private fertility center. Patients were divided into two groups. Group A (Study group): 43 patients received one dose of 0,1mg Triptorelin (GonapeptylÒ Ferring) on the day 6th after donor oocyte retrieval in addition to regular luteal phase support (vaginal progesterone 600-800 mg/day and oral 17 B estradiol 68 mg/day). Group B (Control group): 35 patients received only regular phase support. The study group was conformed according to patients’ agreement to participate. Embryos were transfered at cleaving stage (48-72hs) with Frydman Catheter. Patients with at least one good quality embryo (class I-II) were included. Severe male factor were excluded (WHO criteria).Statistical analysis was performed using SPSS. p<0.05 was considered statistically significant. Categorical variables were expressed as absolute value and percentage using for the comparison chi square test or Fish. RESULTS: Both groups were demographically comparable (age, male factor). The clinical pregnancy, implantation and abortion rates were not statistically different.
e346
ASRM Abstracts
Quality of the evidence
Main results.
Group A (n¼43)
Group B (n¼35)
Age (media) 42,1 41,1 Normal male factor (%) 31 (72%) 27 (77%) Subnormal male factor (%) 12 (28%) 8 (23%) 2 2 N of transfered embryos Implantation Rate (%) 21/86 (24.4%) 17/70 (24%) Clinical Pregnancy Rate (%) 17/43 (35.5%) 12/35 (34,4%) Abortion Rate (%) 3/17 (17%) 4/12 (33,3%)
p Value 0.510 0,378 0,434 1 0.884 0.809 0.59
CONCLUSIONS: The benefit of the injection of a single dose of GnRH in the luteal phase was widely studied in IVF treatments with controversial results. To our knowledge this is one of the few studies presented in ovum donation recipients: Tesarik et al.(1) obtained better implantation and multiple pregnancy rates in the study group but the same pregnancy rates, concluding that GnRH agonist acts on the early embryo and doesn’t improve the endometrium receptivity. On the contrary, our results show that the injection of GnRH agonists in luteal phase in ovum recipients does not improve pregnancy outcomes.Prospective randomized studies in oocyte recipient cycles are needed to elucidate if the drug has indeed an effect on endometrium and implantation mechanisms (2). References: 1. Tesarik J, Hazout A, Mendoza C. Enhancement of embryo developmental potential by a single administration of GnRH agonist at the time of implantatio. Hum Rep 2004;19;5; 1176-1180. 2. Brezina et al. The impact of luteal phase support on endometrial estrogen and progesterone receptor expression: a randomized control trial. reproductive Biology and Endocrinology 2012 10:16. P-699 Wednesday, October 21, 2015 SHORT TERM INTENSIVE LUTEAL PHASE SUPPORT INCREASES LIVE BIRTH RATE IN INTRACYTOPLASMIC SPERM INJECTION CYCLES. B. Demir, I. Kahyaoglu, U. Yildirim, I. Kaplanoglu, L. Mollamahmutoglu. Obstetrics and Gynaecology, Etlik Zubeyde Hanım Women’s Health Teaching and Research Hospital, Ankara, Turkey. OBJECTIVE: Luteal phase support improved the pregnancy outcomes in in vitro fertilization (IVF) cycles. Although many refinements were observed in the reproductive endocrinology, implantation process remains a dilemma. So far, there are no generally accepted protocols for luteal phase support in IVF cycles. Progesteron-based protocols are well established but the dose, duration and the route of the luteal phase supplementation still have quandaries. The aim of this study is to compare the impact of short-term, intensive luteal phase support with intramuscular (IM) and vaginal progesteron (Combined p. group) on the live birth rate in with vaginal progesteron ( Vaginal p. group) in intracytoplasmic sperm injection cycles? DESIGN: Retrospective case-controlled study. MATERIALS AND METHODS: A total of 637 consecutive embryo transferred cycles were included in this case-controlled study. Combined p. group was selected starting to use short-term, intensive progesteron
Vol. 104, No. 3, Supplement, September 2015
Ongoing pregnancy Clinical pregnancy Miscarriage Dissatisfaction Ongoing pregnancy Clinical pregnancy Miscarriage Dissatisfaction
Vaginal progesterone capsules
Oral dydrogesterone
RR (95% CI)
Participants / Studies
Authors’ Interpretation
20% 27% 23% 26% Vaginal progesterone gel 27% 31% 11% 18%
25% (21-31%) 34% (30-39%) 17% (11-26%) 3% (1-10%) Oral dydrogesterone 27% (23-31%) 29% (25-34%) 9% (5-15%) 5% (3-8%)
1.24 (1.02-1.51) 1.24 (1.08-1.41) 0.75 (0.49-1.14) 0.10 (0.02-0.39)
1,611 / 5 2,286 / 6 438 / 5 430 / 1
Dydrogesterone is better Dydrogesterone is better No evidence of difference Dydrogesterone is better
Moderate Moderate Low High
0.97 (0.83-1.13) 0.95 (0.82-1.09) 0.81 (0.48-1.35) 0.26 (0.16-0.42)
1,735 / 2 1,735 / 2 523 / 2 822 / 1
No relevant difference No relevant difference No evidence of difference Dydrogesterone is better
High High Low High
OBJECTIVE: To identify, appraise and summarize the evidence from randomized controlled trials (RCTs) comparing oral dydrogesterone with progesterone for luteal-phase support (LPS) in women undergoing IVF/ICSI. DESIGN: Systematic review and meta-analysis. MATERIALS AND METHODS: Record screening, study selection, data extraction, and evaluation of the risk of bias were performed independently by two authors. The comparison between dydrogesterone and progesterone were summarized as risk ratio (RR) and the precision of the estimates was assessed by the 95% confidence interval (CI). RESULTS: Our electronic search was performed in Mar-17-2015 and 7 studies were included in our quantitative analysis: 5 studies compared oral dydrogesterone with vaginal progesterone capsules; 1 study compared oral dydrogesterone with vaginal progesterone gel; and 1 study has three arms: oral dydrogesterone, vaginal progesterone capsules and vaginal progesterone gel, being considered in both comparisons. We didn’t find any study comparing oral dydrogesterone with intramuscular or oral progesterone. The main results are reported in the table. CONCLUSIONS: The available evidence from RCTs suggests that oral dydrogesterone for LPS provides at least similar reproductive outcomes and less dissatisfaction than vaginal progesterone capsules or gel. Supported by: Conselho Nacional de Desenvolvimento Cientıfico e Tecnol ogico (CNPq); S~ao Paulo Research Foundation (FAPESP). P-698 Wednesday, October 21, 2015 THE ADDITION OF GNRH AGONIST FOR LUTEAL PHASE SUPPORT IN OVUM DONATION CYCLES. P. Casanova,a E. Szlit Feldman,b G. J. Rey Valzacchi,b L. A. Blanco,c C. A. Carrere,b A. Torno,d M. A. Rodriguez Kubrusli,a J. I. Mannara,d V. E. Canada.e aGynecologist Procrearte, Buenos Aires, Argentina; bProcrearte Director, Buenos Aires, Argentina; cReproductive Medicine, Caba, Argentina; dProcrearte, Buenos Aires, Argentina; eProcrearte, Capital Federal, Argentina. OBJECTIVE: To evaluate the effect of 0,1mg triptorelin in a single injection administered to ovum donation recipients the 6th day after donor oocyte retrieval on pregnancy outcomes. DESIGN: Prospective trial. MATERIALS AND METHODS: This study involved 78 ovum donation cycles between August 2014 and February 2015, in a private fertility center. Patients were divided into two groups. Group A (Study group): 43 patients received one dose of 0,1mg Triptorelin (GonapeptylÒ Ferring) on the day 6th after donor oocyte retrieval in addition to regular luteal phase support (vaginal progesterone 600-800 mg/day and oral 17 B estradiol 68 mg/day). Group B (Control group): 35 patients received only regular phase support. The study group was conformed according to patients’ agreement to participate. Embryos were transfered at cleaving stage (48-72hs) with Frydman Catheter. Patients with at least one good quality embryo (class I-II) were included. Severe male factor were excluded (WHO criteria).Statistical analysis was performed using SPSS. p<0.05 was considered statistically significant. Categorical variables were expressed as absolute value and percentage using for the comparison chi square test or Fish. RESULTS: Both groups were demographically comparable (age, male factor). The clinical pregnancy, implantation and abortion rates were not statistically different.
e346
ASRM Abstracts
Quality of the evidence
Main results.
Group A (n¼43)
Group B (n¼35)
Age (media) 42,1 41,1 Normal male factor (%) 31 (72%) 27 (77%) Subnormal male factor (%) 12 (28%) 8 (23%) 2 2 N of transfered embryos Implantation Rate (%) 21/86 (24.4%) 17/70 (24%) Clinical Pregnancy Rate (%) 17/43 (35.5%) 12/35 (34,4%) Abortion Rate (%) 3/17 (17%) 4/12 (33,3%)
p Value 0.510 0,378 0,434 1 0.884 0.809 0.59
CONCLUSIONS: The benefit of the injection of a single dose of GnRH in the luteal phase was widely studied in IVF treatments with controversial results. To our knowledge this is one of the few studies presented in ovum donation recipients: Tesarik et al.(1) obtained better implantation and multiple pregnancy rates in the study group but the same pregnancy rates, concluding that GnRH agonist acts on the early embryo and doesn’t improve the endometrium receptivity. On the contrary, our results show that the injection of GnRH agonists in luteal phase in ovum recipients does not improve pregnancy outcomes.Prospective randomized studies in oocyte recipient cycles are needed to elucidate if the drug has indeed an effect on endometrium and implantation mechanisms (2). References: 1. Tesarik J, Hazout A, Mendoza C. Enhancement of embryo developmental potential by a single administration of GnRH agonist at the time of implantatio. Hum Rep 2004;19;5; 1176-1180. 2. Brezina et al. The impact of luteal phase support on endometrial estrogen and progesterone receptor expression: a randomized control trial. reproductive Biology and Endocrinology 2012 10:16. P-699 Wednesday, October 21, 2015 SHORT TERM INTENSIVE LUTEAL PHASE SUPPORT INCREASES LIVE BIRTH RATE IN INTRACYTOPLASMIC SPERM INJECTION CYCLES. B. Demir, I. Kahyaoglu, U. Yildirim, I. Kaplanoglu, L. Mollamahmutoglu. Obstetrics and Gynaecology, Etlik Zubeyde Hanım Women’s Health Teaching and Research Hospital, Ankara, Turkey. OBJECTIVE: Luteal phase support improved the pregnancy outcomes in in vitro fertilization (IVF) cycles. Although many refinements were observed in the reproductive endocrinology, implantation process remains a dilemma. So far, there are no generally accepted protocols for luteal phase support in IVF cycles. Progesteron-based protocols are well established but the dose, duration and the route of the luteal phase supplementation still have quandaries. The aim of this study is to compare the impact of short-term, intensive luteal phase support with intramuscular (IM) and vaginal progesteron (Combined p. group) on the live birth rate in with vaginal progesteron ( Vaginal p. group) in intracytoplasmic sperm injection cycles? DESIGN: Retrospective case-controlled study. MATERIALS AND METHODS: A total of 637 consecutive embryo transferred cycles were included in this case-controlled study. Combined p. group was selected starting to use short-term, intensive progesteron
Vol. 104, No. 3, Supplement, September 2015