Prolonging GnRH-agonist to achieve ovarian suppression does not compromise the results of a long protocol

In the long gonadotropin-releasing hormone agonist (GnRHa) protocols, stimulation is delayed until complete pituitary-ovarian suppression has been achieved, which usually takes a minimum of 10 days. In women who do not achieve timely suppression we set out to evaluate if prolonging GnRHa affects the results of the IVF process.

We analyzed cycle and pregnancy outcome in 506 consecutive women undergoing IVF-ET after a standardized long GnRHa protocol, according to the time required to achieve ovarian suppression (i.e. estradiol< 40 pg/mL and no follicle >6mm at ultrasound).

Suppression was obtained after 14 GnRHa days in 383 (75.70%) women (Group 1) and 123 (24.30%) women (Group 2) required a mean ± SD (range) of 10 ± 4 (7-28) additional days to achieve complete suppression. Both groups were comparable for baseline clinical and biological characteristics. The rate of cancelled cycles due to poor ovarian response, the number of the oocytes retrieved, fertilization rates, the number and quality of the embryos cultured and transferred were similar in both groups, as well as the pregnancy, implantation and live birth rates. In Group 2, receiver-operator characteristics analysis showed that the probability of pregnancy was not related to the duration of GnRHa treatment.

In a standardized long GnRHa protocol, prolonging desensitization to achieve complete ovarian suppression does not affect the outcome.