New Approach to Uterine Prep


From the Annual Meeting of the American Society for Reproductive Medicine

DENVER – A gonadotropin-releasing hormone antagonist appears to provide significant advantages over conventional GnRH agonist therapy for uterine preparation in recipients of frozen embryo transfer and egg donation cycles, according to Dr. Ilan Tur-Kaspa.

Clinical outcomes were similar with the two strategies in a randomized controlled trial. But patient satisfaction was greater with GnRH antagonist therapy because it entailed a mean of 81% fewer injections. It also enabled women to avoid troublesome estrogen deprivation symptoms – a major patient complaint with GnRh agonist therapy – and eliminated the waiting period between cycles, Dr. Tur-Kaspa reported at the meeting.

The study involved 90 women undergoing 118 randomized embryo transfer cycles. They were assigned to downregulation with a daily subcutaneous injection of 0.25 mg of the GnRH antagonist cetrorelix (Cetrotide) or a midluteal daily injection of 0.25-0.5 mg of the GnRH agonist leuprolide (Lupron). Cetrorelix was started on day 9-11 of estrogen treatment and continued until the day progesterone was started. Leuprolide was started 7 days prior to the anticipated onset of menstruation and continued until the day progesterone was started, explained Dr. Tur-Kaspa, president and medical director of the Institute for Human Reproduction, Chicago.

He calls his GnRH antagonist strategy the EGAP protocol, for Estrogen with GnRH Antagonist followed by Progesterone. The two groups randomized in the trial were comparable in terms of age, body mass index, and endometrial thickness at various key time points. Embryo transfer, implantation, and clinical pregnancy rates were similar in the two study arms. Key outcomes per embryo were also similar in the two groups. (See chart.) There were no significant adverse events in either study arm. Patients randomized to the GnRH agonist received a mean of 26.0 injections, compared with 5.2 injections per patient assigned to the GnRH antagonist.

Dr. Tur-Kaspa said that he serves as an adviser and on the speakers bureau for EMD Serono Inc., which provided partial support for his EGAP trial.

Elsevier Global Medical News

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