Effect of GnRHa on Th17/Treg cells in peripheral blood of patients with unexplained repeated implantation failure

The impact of long-acting Gonadotropin-releasing hormone agonist pretreatment on the clinical pregnancy outcomes of hormone replacement therapy-frozen embryo transfer in recurrent implantation failure patients with and without polycystic ovary syndrome: a retrospective clinical study

BACKGROUND

Several studies have demonstrated that pre-treatment with long-acting Gonadotropin-Releasing Hormone agonists (GnRHa) can significantly enhance the clinical pregnancy rate among recurrent implantation failure (RIF) patients. Investigations have also suggested that GnRHa pre-treatment could ameliorate the clinical pregnancy and live birth rates in polycystic ovary syndrome (PCOS) patients. But there is a dearth of research on whether long-acting GnRHa pre-treatment yields superior clinical outcomes for RIF patients with PCOS.

METHODS

The retrospective study enrolled 1602 patients under the age of 40 meeting the criteria for RIF at the Reproductive Medicine Center of Nanjing Drum Tower Hospital, who underwent frozen-thawed embryo transfer (FET) between January 2017 and December 2021. All cycles were categorized into hormone replacement therapy (HRT) Group (n = 1283) and GnRHa-HRT Group (n = 319), contingent on the usage of long-acting GnRHa pretreatment. Primary outcomes investigated in this study was clinical pregnancy rate, while live birth rate and early miscarriage rate were deemed as secondary outcomes. Univariate analysis and a multivariate logistic regression model were employed to assess the impact of GnRHa pretreatment on the clinical pregnancy rate in RIF patients. The influence of long-acting GnRHa pretreatment on clinical pregnancy outcomes was re-examined in PCOS and non-PCOS subgroups. Additionally, an interaction analysis was performed to evaluate the effect of PCOS on the relationship between long-acting GnRHa pretreatment and the clinical pregnancy rate.

RESULTS

Multiple regression analysis showed that long-acting GnRHa pretreatment had a positive impact on the clinical pregnancy rate (aOR = 1.51, 95%CI: 1.15-1.99, P = 0.003). We divided the RIF population into two subgroups, for PCOS patients, although the clinical pregnancy rate was higher in women who received GnRHa pretreatment compared to those who did not, it was not statistically significant (aOR = 1.51, 95%CI: 0.81-2.82, P = 0.195). Interaction analysis suggested that for PCOS patients, there was no significant difference in the clinical pregnancy rate between women who received GnRHa pretreatment and those who did not (P interaction = 0.818), indicating that the effect of GnRHa pretreatment on the clinical pregnancy rate was not influenced by PCOS.

CONCLUSIONS

Our study demonstrates that long-acting GnRHa pretreatment can enhance clinical pregnancy outcomes in patients with RIF. Among RIF patients without PCOS, the clinical pregnancy rate exhibited a significant increase following GnRHa pretreatment compared to the control group. However, in RIF patients with concurrent PCOS, there was no significant elevation in the clinical pregnancy rate post-GnRHa pretreatment. Therefore, GnRHa pretreatment is effective in improving pregnancy outcomes for RIF patients. However, whether GnRHa pretreatment is suitable for RIF patients with PCOS requires more cautious clinical discussion.

The effect of gonadotropin-releasing hormone agonist downregulation in conjunction with hormone replacement therapy on endometrial preparation in patients for frozen-thawed embryo transfer

Objective

To investigate the effects of combining gonadotropin-releasing hormone agonist (GnRHa) downregulation with hormone replacement therapy (HRT, GnRHa-HRT) on the clinical outcomes of patients undergoing frozen-thawed embryo transfer (FET).

Methods

In this retrospective study, we included patients who had FET between January 2018 and December 2022. They were categorized into HRT and GnRHa-HRT groups based on the endometrial preparation protocol. The study compared the clinical outcomes of patients in two groups. Possible factors affecting clinical outcomes were analyzed using univariate analysis. To analyze the impact of two endometrial preparation methods on clinical outcomes, multifactorial logistic regression was performed.

Results

The rates of clinical pregnancy (47.31% vs. 59.60%), embryo implantation (37.58% vs. 49.65%), biochemical pregnancy (52.36% vs. 64.31%), and early abortion (7.07% vs. 10.77%) were statistically different between the two groups (p < 0.05). Analysis using multifactorial logistic regression showed that there was a 1.65-fold increase in clinical pregnancy rates (OR = 1.65, 95% CI: 1.29-2.12, p < 0.001) and a 1.55-fold increase in embryo implantation rates (OR = 1.55, 95% CI: 1.27-1.90, p < 0.001) in the GnRHa-HRT group when compared to the HRT group. For blastocyst transfer, the clinical pregnancy and implantation rates of the GnRHa-HRT group were significantly higher than those of the HRT group (OR = 1.75, 95% CI: 1.30-2.37, p < 0.001; OR = 1.73, 95% CI: 1.35-2.21, p < 0.001).

Conclusion

In FET cycles, leuprorelin (as a GnRHa) downregulation combined with HRT may improve the clinical outcome of patients compared to the HRT cycle, especially for the clinical pregnancy and embryo implantation rates of patients with blastocyst transfer.

Additional single dose GnRH agonist during luteal phase support may improve live birth rate in GnRHa-HRT frozen-thawed embryo transfer cycle: a retrospective cohort study

BACKGROUND

GnRH agonist (GnRHa) has been reported to have direct effects and functional roles in the endometrium and embryos. Several meta-analyses have shown that GnRHa administration in the luteal phase improved the live birth rate or pregnancy rate in both fresh and frozen embryo transfer (FET) cycles. The aim of this study was to investigate whether luteal GnRHa administration could also improve in vitro fertilization (IVF) outcomes in patients undergoing hormone replacement therapy (HRT) cycles with GnRHa suppression.

METHODS

The retrospective cohort study included a total of 350 patients undergoing GnRHa-HRT FET cycles. The study group included 179 patients receiving an additional single dose of GnRHa in the luteal phase following embryo transfer. A total of 171 patients in the control group did not receive luteal GnRHa. The baseline and cycle characteristics and reproductive outcomes were compared between the two groups.

RESULTS

Baseline and cycle characteristics were similar between the two groups, except lower AMH levels were found in the luteal GnRHa group than in the control group. The luteal GnRHa group had a significantly higher ongoing pregnancy rate and live birth rate than the control group. The multivariate analysis revealed that luteal GnRHa administration was positively associated with ongoing pregnancy (OR 2.04, 95% CI 1.20-3.47, P = 0.008) and live birth (OR 2.03, 95% CI 1.20-3.45, P = 0.009). When the subgroup of patients with recurrent implantation failure was analyzed, the multivariate analysis also showed that luteal GnRHa administration had beneficial effects on ongoing pregnancy (OR 4.55, 95% CI 1.69-12.30, P = 0.003) and live birth (OR 4.30, 95% CI 1.59-11.65, P = 0.004).

CONCLUSIONS

Our data suggest that the addition of one luteal dose of GnRHa may improve the live birth rate in patients undergoing the GnRHa-HRT protocol.

Transcriptome analysis of eutopic endometrium in adenomyosis after GnRH agonist treatment

BACKGROUND

Adenomyosis is a chronic gynecological disease characterized by invasion of the uterine endometrium into the muscle layer. In assisted reproductive technology (ART), gonadotropin-releasing hormone agonist (GnRHa) is often used to improve pregnancy rates in patients with adenomyosis, but the underlying mechanisms are poorly understood.

METHODS

Eutopic endometrial specimens were collected from patients with adenomyosis before and after GnRHa treatment in the midsecretory phase. RNA sequencing (RNA-Seq) of these specimens was performed for transcriptome analysis. The differentially expressed genes (DEGs) of interest were confirmed by real-time PCR and immunohistochemistry.

RESULTS

A total of 132 DEGs were identified in the endometrium of patients with adenomyosis after GnRHa treatment compared with the control group. Bioinformatics analysis predicted that immune system-associated signal transduction changed significantly after GnRHa treatment. Chemokine (C-C motif) ligand 21 (CCL21) was found to be highly expressed in the eutopic endometrium after GnRHa treatment, which may be involved in the improvement of endometrial receptivity in adenomyosis.

CONCLUSION

This study suggests that molecular regulation related to immune system-associated signal transduction is an important mechanism of GnRHa treatment in adenomyosis. Immunoreactive CCL21 is thought to regulate inflammatory events and participate in endometrial receptivity in adenomyosis.