GnRH agonist protokolü IVFsikluslarında GnRH antagonist protokol kadar etkin midir?

Öz

Giriş/Amaç:IVF-ET uygulanan 1000 siklusun GnRH antagonist ve agonist protokollerinin etkinliğinin karşılaştırılması amaçlanmıştır. Gereç ve Yöntemler:1000 siklus çalışmaya dahil edilmiştir,bu siklusların 283?üne agonist protokol,717?sine antagonist protokol uygulanmıştır. Her iki protokol grubu demografik özellikleri, tedavi karakteristikleri, gebelik oranları açısından karşılaştırılmıştır. Bulgular:Agonist protokol grubunda ?coasting? uygulaması ve OHSS gelişimi istatistiksel olarak yüksekti (p<0,001).Siklus iptal oranlarına bakıldığında antagonist protokol grubunda istatistiksel olarak anlamlı derecede yüksekti (p<0,001). Agonist protokol grubunda siklus başına kimyasal gebelik oranı %40,3 iken antagonist protokol grubunda %28,5?tir (p<0,001). Agonist protokol grubunda klinik gebelik oranı %31,4 devam eden gebelik oranı %27,2 iken antagonist grupta sırasıyla %27,2 ve %25,1?di(sırasıyla p=0,179 ve p=0,115). Agonist ve antagonist protokol grubunda transfer başına kimyasal gebelik oranı agonist protokol grubunda %42,1,antagonist protokol grubunda %32,8 idi . Agonist protokol grubunda bu oran istatistiksel olarak anlamlı derecede yüksek bulundu (p=0,08). Agonist protokol grubunda transfer başına klinik gebelik oranı %32,8,devam eden gebelik oranı %28,4?tü. Antagonist protokol grubunda bu oranlar sırasıyla %31,4,%28,9?du. Her iki protokol grubunda agonist gruptaki bu yükseklik istatistiksel olarak anlamlı değildi (sırasıyla p=0,660 ve p=0,873). Çalışmamızda klinik gebelik üzerine her iki protokol grubunun etkileri benzer bulunmuştur (OR=0,814,%95 CI=0,603-1,099;p=0,18). Kimyasal gebelik üzerinde GnRH agonist protokol daha başarılı bulunmuştur (OR =1,696,%95 CI=1,272-2,262;p<0,001). Devam eden gebelik üzerine etkisine bakıldığında her iki protokolün etkisinin benzer olduğu bulunmuştur (OR=1,115,%95 CI=0,817-1,523 ;p=493). Sonuç:GnRH agonist ve GnRH antagonist protokol grubunda benzer klinik ve devam eden gebelik oranları bulunmuştur. GnRH agonist protokolün uzun stimülasyon süresi ve OHSS görülme sıklığı nedeniyle son yıllarda GnRH antagonist protokol seçimi tedavilerde öncelikle tercih edilmektedir.

Anahtar Kelimeler

• GnRH agonist protokol
• GnRH antagonist protokol
• in vitro fertilizasyon
• klinik gebelik oranı
• overyan hiperstimülasyon sendromu

Is GnRH agonist protocol as effective as GnRH antagonist protocol in IVF cycles?

Abstract

Objective:Aim of this study is to compare effectiveness of gonadotrophin releasing hormone (GnRH) agonist in-vitro fertilization(IVF) cycles compared to GnRH antagonist IVF cycles Methods:In all, 1000 fresh cycles were used in analysis.GnRH agonist and GnRH antagonist were compared. Primary outcome measure of the study was ongoing pregnancy rate after 12 weeks of gestation. Results:Agonist cycles had significantly more cases of coasting and OHSS (p<0,001). Cycle cancellation rates were more common in GnRH antagonist group (p<0,001).Biochemical pregnancy rates were higher in the GnRH agonist group (40.3% vs 28.5%) (p<0,001). Clinical pregnancy and ongoing pregnancy rates were higher in the GnRH agonist group (31,4% and 27,2% respectively) compared to GnRH antagonist group (27,2%, and 25,1% respectively)(p=0,179 and p=0,115 ). Biochemical pregnancy rates per cycle were higher in the GnRH agonist group (42,1% vs 32,8%) (p=0,008). Clinical pregnancy and ongoing pregnancy rates per cycle in GnRH agonist group (32,8% and 28,4%) were higher compared to GnRH antagonist group (31,4% and 28,9%,) (p=0,660) We found no significant difference in clinical pregnancy between groups(OR=0,814, 95% CI=0,603-1,099;p=0,18). GnRH agonist protocol was more succesful in biochemical pregnancy OR =1,696, 95 %CI=1,272-2,262;p<0,001). The ongoing pregnancy rates were similar between groups (OR=1,115, 95% CI=0,817-1,523 ;p=493). Conclusion:GnRH agonist cycles have longer induction duration, and higher rates of OHSS, and similar pregnancy rates with antagonist cycles. GnRH agonist use in IVF cycles is falling behind GnRH antagonist use in contemporary practice.

Keywords

• GnRH agonist protocol
• GnRH antagonist protocol
• in vitro fertilisation
• clinical pregnancy rate
• overian hyperstimulation syndrome

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