GnRH analogues: applications in assisted reproductive techniques.

Area of Science:

• Reproductive Endocrinology
• Assisted Reproductive Techniques (ART)

Background:

• The development of GnRH agonists revolutionized ART by preventing premature luteinization, a common issue with superovulated cycles.
• GnRH agonists were widely adopted in the 1980s, but protocols offered limited flexibility in pituitary suppression and faced debate regarding LH's role in follicular development.

Observation:

• GnRH antagonists, introduced in 2001, provide immediate suppression of gonadotropins, including LH.
• Their administration after exogenous stimulation shortens treatment cycles and offers a reduced side-effect profile compared to agonists.
• Despite initial skepticism, large trials demonstrate comparable pregnancy rates to established agonist regimens.

Findings:

• GnRH antagonists are increasingly adopted in ART due to patient preference and shorter cycle lengths.
• Current research indicates comparable efficacy between GnRH antagonists and agonists in achieving successful ART outcomes.
• Patient-reported outcomes and reduced side effects favor GnRH antagonists.

Implications:

• The shift towards GnRH antagonists aligns with a move towards milder stimulation protocols in ART.
• There is a growing emphasis on long-term outcomes, such as live singleton births, over surrogate markers like oocyte yield.
• This evolution in ART practice prioritizes patient well-being and sustainable reproductive success.