Is the type of gonadotropin-releasing hormone suppression protocol for ovarian hyperstimulation associated with ectopic pregnancy in fresh autologous cycles for in vitro fertilization?

Autor: Aarti Bhasin, Laura Londra, Caroline Moreau, Donna M. Strobino, Yulian Zhao
Rok vydání: 2016
Předmět:
Adult
0301 basic medicine
Agonist
endocrine system
medicine.medical_specialty
medicine.drug_class
medicine.medical_treatment
Fertilization in Vitro
Gonadotropin-releasing hormone
Luteal phase
Fertility Agents
Gonadotropin-Releasing Hormone
Andrology
03 medical and health sciences
Hormone Antagonists
0302 clinical medicine
Ovulation Induction
Pregnancy
Risk Factors
Internal medicine
Odds Ratio
Humans
Medicine
030219 obstetrics & reproductive medicine
In vitro fertilisation
Assisted reproductive technology
Ectopic pregnancy
business.industry
Obstetrics and Gynecology
Odds ratio
Embryo Transfer
medicine.disease
Embryo transfer
Pregnancy
Ectopic
Fertility
Logistic Models
Treatment Outcome
030104 developmental biology
Endocrinology
Reproductive Medicine
Infertility
Multivariate Analysis
Female
business
hormones
hormone substitutes
and hormone antagonists
Zdroj: Fertility and Sterility. 106:666-672
ISSN: 0015-0282
DOI: 10.1016/j.fertnstert.2016.05.019
Popis: Objective To evaluate the association between different ovarian hyperstimulation protocols and ectopic pregnancy (EP) in in vitro fertilization (IVF) cycles in fresh autologous embryo transfer cycles in the United States between 2008 and 2011 as reported to the Society of Assisted Reproductive Technology (SART). Design Historical cohort study. Setting Not applicable. Patient(s) None. Intervention(s) None. Main Outcome Measure(s) All autologous cycles that resulted in a clinical pregnancy after a fresh, intrauterine embryo transfer and described characteristics of cycles according to protocol were included: luteal GnRH agonist, GnRH agonist flare, or GnRH antagonist. Multivariate logistic regression was conducted to investigate the association between type of protocol and EP. Result(s) Among 136,605 clinical pregnancies, 2,645 (1.94%) were EP. Ectopic pregnancy was more frequent with GnRH antagonist (2.4%) cycles than with GnRH agonist flare (2.1%) or luteal GnRH agonist (1.6%) cycles. After adjusting for maternal and treatment characteristics, the GnRH antagonist and the GnRH agonist flare protocols were associated with increased odds of EP (adjusted odds ratio [aOR] 1.52; 95% confidence interval [CI], 1.39–1.65; and aOR 1.25; 95% CI, 1.09–1.44, respectively) compared with luteal GnRH agonist. Analysis of differences in the factors related to EP in luteal GnRH agonist versus GnRH antagonist protocols indicated that diminished ovarian reserve was associated with an increased risk of EP in luteal GnRH agonist but not in GnRH antagonist cycles. Conclusion(s) The type of protocol used during ovarian hyperstimulation in fresh autologous cycles was associated with EP. This finding suggests a role for extrapituitary GnRH on the tubal and uterine environment during ovarian hyperstimulation treatment for IVF.
Databáze: OpenAIRE
Externí odkaz: