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[Biological effects of GnRH antagonists]
A Devaux1, J-L Pouly, A Bachelot
1FIVNAT, CHU Bicêtre, 82, rue du Général-Leclerc, 94276 Le Kremlin-Bicêtre, France. aviva.devaux@bch.ap-hop-paris.fr
Gynecologie, Obstetrique & Fertilite
|September 24, 2004
Summary
GnRH antagonists may reduce pregnancy rates in assisted reproductive technology (ART) despite similar stimulation response. Further research is needed to understand the impact on oocyte retrieval, embryo development, and implantation.
Area of Science:
- Reproductive Endocrinology
- Assisted Reproductive Technology (ART)
Context:
- Gonadotropin-releasing hormone (GnRH) antagonists are used in ART to prevent luteinizing hormone (LH) surges.
- Previous studies suggested a potential decrease in pregnancy rates with GnRH antagonist use.
Purpose:
- To compare clinical and biological parameters between GnRH agonist long protocol and GnRH antagonist treatment in ART.
- To evaluate the efficacy of GnRH antagonists versus agonists in women undergoing in vitro fertilization (IVF).
Summary:
- A large-scale study compared 20,761 ART attempts in women under 35.
- While stimulation response, fertilization, and embryo development were similar, GnRH antagonists were associated with lower gonadotropin doses and shorter stimulation duration.
- Significantly decreased oocyte retrieval, embryo yield, and pregnancy rates were observed with GnRH antagonists (P < 0.001).
Impact:
- Findings suggest GnRH antagonists may negatively impact ART outcomes, potentially due to endometrial modifications or effects on hormone levels.
- Mechanisms may involve cell cycle inhibition, altered folliculogenesis, and compromised implantation.
- Further investigation is crucial to elucidate these effects and inform patient counseling regarding GnRH antagonist benefits and drawbacks.