P-312 Effect on pregnancy outcomes of depot GnRH agonist pre-treatment before frozen-thawed embryo transfer cycles in patients with adenomyosis
Authors: Göktürk U , Kahraman S 
Published: June 2022

Abstract

Study question
Is there any difference between using or not using depot GnRH agonist pre-treatment on pregnancy outcomes in patients with adenomyosis before frozen-thawed embryo transfer cycles?

Summary answer
GnRH agonist pre-treatment before frozen-thawed embryo transfer has no effect on pregnancy outcomes in adenomyosis patients.

What is known already
Uterine adenomyosis negatively affects implantation and clinical pregnancy rates and also increases the risk of early pregnancy loss. Increased inflammatory markers and increased myometrial peristalsis are thought to decrease the rate of implantation. Depot GnRH agonist pre-treatment is thought to increase implantation rate by both decreasing myometrial contractility and reducing inflammatory marker production.

Study design, size, duration
This retrospective cohort study was conducted at ART and Reproductive Genetics Centre, Memorial Sisli Hospital, Istanbul, Turkey. Patients with adenomyosis undergoing a FET cycle between 2011 and 2021 were evaluated. Patients between 25-45 years old with good and top-quality blastocysts were included and preimplantation genetic diagnosis (PGD) was applied to patients who were &gt;37 years old. A total of 144 frozen embryo transfer cycles were examined.

Participants/materials, setting, methods
Diagnosis of adenomyosis was made using transvaginal ultrasound and/or pelvic magnetic resonance imaging which revealed an asymmetrically thickening between the anterior and posterior uterine walls, focal adenomyosis, myometrial cysts and irregular/interrupted junctional zone of the endometrium. 65 patients in the study group (Group I) who received depot GnRH agonist pre-treatment for minimum 2 and maximum 6 months and 79 patients without GnRH agonist pre-treatment (Group 2) were evaluated.

Main results and the role of chance
There was no significant difference in patient characteristics such as age, endometrial thickness on embryo transfer day, BMI, infertility duration, and anti mullerian hormone levels between groups 1 and 2. Endometrial preparation was done using artificial cycle in the depot agonist group, whereas both artificial and modified natural cycle were used in patients without depot GnRH agonist pre-treatment.The pregnancy rate was 53.8%(n = 35) in group 1 and 54.4%(n = 43) in group 2. The clinical pregnancy loss rate was 20% (n = 9) in group 1 and 15.7% (n = 6)in group 2. The live birth rate was 40% (n = 26) in group I and 39.2. (n = 31) in group II. There were no statistically significant differences in pregnancy rates, clinical pregnancy losses, and live birth rates between the groups.

Limitations, reasons for caution
The limitation of the study is its retrospective nature.

Wider implications of the findings
The lack of any statistically significant differences in pregnancy outcomes in this study suggests the need for further evaluation of the value/effectiveness of GnRHa treatment in adenomyosis patients before embryo transfer cycles.

Trial registration number
not applicable