VOLUME 10, ISSUE 2, ARTICLE 1
Received: 10-Jun-2021
Accepted: 03-Oct-2021
Published: 08-Oct-2021
The luteal phase (LP) in the fresh ICSI cycle is insufficient, adequate LP support is one of the approved treatments for improving implantation and pregnancy rates. It is generally known that the LP is inadequate after ovarian stimulation due to negative from supra-physiological blood levels of steroids released by numerous corporal luteal, LH concentrations are low during the luteal phase. In this study, patients were divided into two groups: (40) patients as study group; those who received GnRHa (Decapeptil 0.1 mg), three days after embryo transfer, in addition to conventional luteal phase support (LPS) in the LP to increase the implantation and pregnancy rate in IVF; and their control group (40) received standard LPS only. On the second day of stimulation, blood samples for FSH, LH, TSH, E2, and prolactin were taken. On the day of ovulation induction, measure E2, progesterone, and LH; and on the day of embryo transfers, measure progesterone and LH. The overall characteristics of the patients in both groups were not significantly different. There was also no significant change in the number of total oocytes, mean of metaphase II oocytes percent, cleavage rate, grade I embryo percent, or serum hormones level between the study and control groups (p > 0.05). GnRH agonist treatment in the luteal phase improves clinical pregnancy and implantation rate in fresh ICSI cycles but is not statistically significant.
1. Introduction
Infertility is a big issue that many couples confront at some point in their lives. Reproductive medicine faces a difficult task in dealing with infertility issues. Infertility is estimated to affect 10% to 15% of the world's population (Moridi et al., 2019 [1]). Infertility is defined as "the inability to achieve a clinical pregnancy following 12 months of regular, unprotected sexual intercourse" according to an updated worldwide dictionary on infertility and reproductive treatments (Zegers-Hochschild et al., 2017 [2]). Fertility counseling, medical and/or surgical therapy of the underlying reason, fertility drugs, and assisted reproductive technologies (ARTs) are all part of infertility management (Nardelli et al., 2014 [3]). All procedures that entail the in-vitro handling of both human oocytes and sperm or embryos for the aim of reproduction are referred to as assisted reproductive technologies (ART). Despite considerable advances in assisted reproductive technology (ART) that have overcome many of the underlying reasons for infertility, pregnancy rates remain low (Zhang et al., 2013 [4]). Positive yield in a series of IVF phases, including controlled ovarian stimulation (COS), ovum pick-up (OPU), fertilization, embryo transfer, and implantation, determines IVF success (Tola, EN 2019 [5]). In ART therapy, successful implantation is a must-have result. Despite considerable efforts to improve, this result remains restricted. In reality, only around a third of instances involving one or more embryos result in a live delivery (ESHRE, 2016 [6]), (Chambers et al., 2017 [7]). Because the luteal phase in fresh cycles is deficient, adequate luteal phase support is one of the acceptable methods to increase implantation and pregnancy rates (Humaidan et al., 2015 [8]), (van der Linden et al., 2015 [9]). It is generally known that there is an inadequate luteal phase after ovarian stimulation (Chau et al., 2019 [10]). Because of supra-physiological blood levels of steroids generated by many corpora lutea, LH concentrations are low during the luteal phase due to negative feedback on the pituitary gland (Thomsen et al., 2018 [11]). LH is an important hormone for maintaining corpus luteum function and enhancing angiogenic factors, growth factors, and cytokines that can help in implantation. LH inhibition causes early luteolysis or a considerable shortening of the luteal phase (Chau et al., 2019 [10]). As a result, fertility therapy with new cycles necessitates sufficient luteal support. GnRH agonist (GnRHa) has been shown to help with the luteal phase. On the one hand, it is thought that GnRHa, given at the right dose, can maintain its stimulatory action, allowing LH production to continue through the luteal phase (Fusi et al., 2019 [12]).
2. Materials and Methods
During the period November 2018 to September 2020, this prospective comparative study was conducted on 80 infertile women who were undergoing ICSI at Infertility Center of the High Institute for Infertility Diagnosis and Assisted Reproductive Technologies/ Reproductive Physiology, Al Nahrain University, Baghdad, Iraq. The Local Medical Ethical Committee of Al Nahrain University's High Institute for Infertility Diagnosis and Assisted Reproductive Technologies granted the current study ethical permission. In addition, each participant signed a formal informed consent form. In the ICSI laboratory of the High Institute for Infertility Diagnosis and Assisted Reproductive Technologies, the morphological examination of oocytes aspirated from the ovaries of infertile females and their resultant embryos was performed. The serum hormones were measured in a private laboratory using mini VIDAS. The participants in this study were 80 infertile females having ICSI cycles, ranging in age from 23 to 42 years old and infertility length from 4 to 13 years. In this study, women with both primary and secondary infertility were included. Some women have already had IVF/ICSI cycles, while others have not. A proportion of the women that were recruited had polycystic ovarian syndrome (PCOS). The fallopian tube was blocked in certain women. Following comprehensive standard assessment, a specific reason was not established in a proportion of couples, hence they were categorized as having unexplained infertility.
The study was designed to be a comparative prospective study. The selected 80 women are randomly divided into two groups:
A. Study group: In addition to regular luteal phase sport (LPS), 40 women underwent antagonist protocol with human chorionic gonadotrophin (HCG) trigger and got a single dose of GnRHa (Decapeptil 0.1 mg) on day 6 following ova pick-up (OPU).
B. Control group: 40 women undergo antagonist protocol with human chorionic gonadotrophin (HCG) trigger received standard luteal phase support only (LPS)
3. Results
The overall characteristics of the patients in both groups (the research group and the control group) were not significantly different, including age, weight, type of infertility (primary or secondary), reason of infertility, and length of infertility, as shown in Table 1. Follicle stimulating Hormone, Luteinizing Hormone, Estradiol, Thyroid stimulating Hormone; Prolactin and Progesterone levels were measured for both groups with 0.892 p value for the TSH being the highest response as shown in Table 2. Also, additional results were provided for the hormonal levels at the day of trigger of ET, with the highest p value for the Estradiol 0.793 at the day of trigger, these results were shown in Table 3 and Table 4. There was also no significant difference in total oocytes number, mean metaphase II oocytes percent, mean metaphase I percent, mean germinal vesicle oocyte percent, mean cleavage rate, mean grade I embryo percent, mean grade II embryos percent, or mean serum hormones level between the study and control groups (p > 0.05), as shown in Table 5 and Table 6. Although no statistical evidence was found (p> 0.05), the study group that received GnRHa hormone 3 days after the embryo transfer, in addition to the standard luteal phase support (LPS) in the secretory phase of the fresh ICSI cycles, had a higher clinical pregnancy and implantation rate than the control group that received LPS only in the secretory phase. The implantation rate was 0.614 with the study group showing higher percentage of response than the control group, as shown in Figure 1. Pregnancy and twin pregnancy were compared between study groups as shown in Table 7 and Table 8.
Table (1): Comparison of demographic features between study and control groups
Table (2): Comparison of basal hormonal levels between study and control groups
Table (3): Comparison of hormonal levels at the day of trigger between study and control groups
Table (4): Comparison of Progesterone and LH at day of ET between control and study groups
Table (5): Comparison of oocytes characteristics between control and study group
Table (6): Comparison of embryo characteristics between study and control groups
Figure (1): Comparison of implantation rate between study and control groups
Table (7): Comparison of pregnancy outcome between control and study group
Table (8): Comparison of twin pregnancy rate between control and study groups
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Peer Review Information
Double-Blind Peer Review in which both authors and reviewers does not know each other.
This work was reviewed by
Asst. Prof. Dr. Manal T. Al-Obaidi
Asst. Prof. Dr. Ali Ibrahim Rahim
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The editorial policy at IJEIR ensured that this article fit the standards of scientific publications.
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Authors at OrcID
Nadia Al-Hilli https://orcid.org/0000-0002-4486-9459Alaa S; Al-Hilli N; Jwad MA; Effect of Administration of Single Dose GnRH Agonist in Luteal Phase on Implantation Rate of Fresh ICSI Cycles; Iraqi Journal of Embryos and Infertility Researches (IJEIR), (2021); 10(2): 1-14.