International Journal of
Reproductive Biomedicine
Sat, Dec 21, 2024
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Volume 21, Issue 6 ( June 2023 2023)
IJRM 2023, 21(6): 481-490 |
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Moini A, Eslami Moayed M, Kashani L, Farid Mojtahedi M, Rezaee T, Tabasizadeh H, et al . Pregnancy outcomes in women with adenomyosis, undergoing artificial endometrial preparation with and without gonadotropin-releasing hormone agonist pretreatment in frozen embryo transfer cycles: An RCT. IJRM 2023; 21 (6) :481-490
URL: http://ijrm.ir/article-1-2668-en.html
URL: http://ijrm.ir/article-1-2668-en.html
Ashraf Moini * 
1, Marzieh Eslami Moayed2 , Ladan Kashani3 , Maryam Farid Mojtahedi3 , Tawoos Rezaee3 , Hamed Tabasizadeh4 , Khadije Maajani5 , Nazila Yamini6
1, Marzieh Eslami Moayed2 , Ladan Kashani3 , Maryam Farid Mojtahedi3 , Tawoos Rezaee3 , Hamed Tabasizadeh4 , Khadije Maajani5 , Nazila Yamini6
1- Department of Gynecology and Obstetrics, Arash Women’s Hospital, Tehran University of Medical Sciences, Tehran, Iran. , a_moini@royaninstitute.org
2- Department of Gynecology and Obstetrics, Arash Women’s Hospital, Tehran University of Medical Sciences, Tehran, Iran. Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran. Breast Disease Research Center (BDRC), Tehran University of Medical Sciences, Tehran, Iran.
3- Department of Gynecology and Obstetrics, Arash Women’s Hospital, Tehran University of Medical Sciences, Tehran, Iran.
4- Department of Pediatrics, Clinical Research Development Unit, Bahar Hospital, Shahroud University of Medical Sciences, Shahroud, Iran.
5- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
6- Department of Embryology, Arash Women’s Hospital, Tehran University of Medical Science, Tehran, Iran.
2- Department of Gynecology and Obstetrics, Arash Women’s Hospital, Tehran University of Medical Sciences, Tehran, Iran. Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran. Breast Disease Research Center (BDRC), Tehran University of Medical Sciences, Tehran, Iran.
3- Department of Gynecology and Obstetrics, Arash Women’s Hospital, Tehran University of Medical Sciences, Tehran, Iran.
4- Department of Pediatrics, Clinical Research Development Unit, Bahar Hospital, Shahroud University of Medical Sciences, Shahroud, Iran.
5- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
6- Department of Embryology, Arash Women’s Hospital, Tehran University of Medical Science, Tehran, Iran.
Abstract: (744 Views)
Background: Selecting a suitable and preferable method for endometrial preparation in frozen embryo transfer (FET) cycles for women with adenomyosis is still challenging in infertility treatment.
Objective: To compare 2 artificial endometrial preparation regimens with and without gonadotropin-releasing hormone agonist (GnRHa) pretreatment in women with adenomyosis undergoing FET cycles.
Materials and Methods: This randomized clinical trial study was conducted on 140 adenomyosis cases who underwent FET cycles at Arash Women’s hospital, Tehran, Iran from May 2020 to March 2021. Participants were randomly allocated into hormonal replacement therapy (HRT) and HRT+GnRHa pretreatment groups (n = 70/each). Endometrial preparation with 2-6 mg daily estradiol was started in the HRT+GnRHa group, taking after down-regulation with the GnRHa. Within the HRT group, the same dose of estradiol was commenced within the early follicular stage. The main (chemical and clinical pregnancy rates) and auxiliary results (twin pregnancy, miscarriage, and live birth rates) were compared between groups.
Results: The demographic characteristics and severity of adenomyosis, endometrial thickness, and pattern at starting progesterone administration were similar in the 2 groups, and triple-line endometrium was found to be the dominant pattern in both groups (p = 0.65). No significant differences were observed in chemical, clinical, and twin pregnancy rates as well as miscarriage and live birth rates between groups (p = 0.71, p = 0.81, p = 0.11, and p = 0.84, respectively). However, the total estrogen dose and duration of estrogen consumption were significantly higher in the pretreatment group (p = 0.001, and p = 0.003).
Conclusion: These results indicated that the hormonal endometrial preparation with estrogen and progestin for FET cycles is as efficacious as a protocol involving preceding pituitary suppression with a GnRHa. Further large randomized clinical studies are required to confirm these findings.
Objective: To compare 2 artificial endometrial preparation regimens with and without gonadotropin-releasing hormone agonist (GnRHa) pretreatment in women with adenomyosis undergoing FET cycles.
Materials and Methods: This randomized clinical trial study was conducted on 140 adenomyosis cases who underwent FET cycles at Arash Women’s hospital, Tehran, Iran from May 2020 to March 2021. Participants were randomly allocated into hormonal replacement therapy (HRT) and HRT+GnRHa pretreatment groups (n = 70/each). Endometrial preparation with 2-6 mg daily estradiol was started in the HRT+GnRHa group, taking after down-regulation with the GnRHa. Within the HRT group, the same dose of estradiol was commenced within the early follicular stage. The main (chemical and clinical pregnancy rates) and auxiliary results (twin pregnancy, miscarriage, and live birth rates) were compared between groups.
Results: The demographic characteristics and severity of adenomyosis, endometrial thickness, and pattern at starting progesterone administration were similar in the 2 groups, and triple-line endometrium was found to be the dominant pattern in both groups (p = 0.65). No significant differences were observed in chemical, clinical, and twin pregnancy rates as well as miscarriage and live birth rates between groups (p = 0.71, p = 0.81, p = 0.11, and p = 0.84, respectively). However, the total estrogen dose and duration of estrogen consumption were significantly higher in the pretreatment group (p = 0.001, and p = 0.003).
Conclusion: These results indicated that the hormonal endometrial preparation with estrogen and progestin for FET cycles is as efficacious as a protocol involving preceding pituitary suppression with a GnRHa. Further large randomized clinical studies are required to confirm these findings.
Keywords: Adenomyosis, Embryo transfer, Hormone replacement therapy, Gonadotropin-releasing hormone.
Type of Study: Original Article |
Subject:
Assisted Reproductive Technologies
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