Impact of single vs. multiple GnRH-agonist doses for luteal phase support in antagonist ICSI cycles: a three-arm randomized controlled trial

Abstract

Abstract. Background: All stimulated ART cycles had inadequate luteal phase (LP), according to many studies. Current LPS regimens utilizing progesterone alone may not always be enough to promote implantation. The novel use of gonadotropin-releasing hormone agonists (GnRH-a) is increasing, aiming to enhance reproductive outcomes. Most studies evaluating the efficacy of GnRH-a for LPS used the long GnRH-a protocol with conflicting results. This study was conducted to assess whether administration of single or multiple doses of GnRH-agonists in the luteal phase improves clinical outcomes in intracytoplasmic sperm injection cycles (ICSI) using the GnRH antagonist protocol. Methods: In a single-centre, parallel, open-label, three-arm randomized controlled trial, 75 infertile women undergoing ICSI cycles were randomized into three groups according to luteal phase support (LPS) regimens. The study involved adding a single subcutaneous injection of 0.1 mg triptorelin on the 6^th day after oocyte retrieval (group I; n = 25), multiple doses of triptorelin on the 5^th, 7^th, and 9^th days after oocyte retrieval (group II; n = 25), or a control group with no added triptorelin (group III; n = 25) to routine LPS with progesterone. Results: No statistical differences were detected between the groups regarding clinical pregnancy, implantation, multiple pregnancy rates or β-hCG concentration. The clinical pregnancy rate (CPR) was slightly higher in the multiple-dose group (72%), vs. 60% and 52% for the single-dose group and control group, respectively (p = 0.334). Conclusions: Compared to progesterone alone, the addition of mid-luteal GnRH agonists did not significantly improve implantation or CPR. However, the multiple-dose addition showed promisingly higher CPR, warranting further research.