Impact of the gonadotropin-releasing hormone antagonist in oocyte donation cycles

Post-marketing safety profile of ganirelix in women: a 20-year pharmacovigilance analysis of global adverse drug event databases (2004-2024)

BACKGROUND

Ganirelix, a third-generation GnRH antagonist, is widely used in assisted reproductive technology (ART) for rapid pituitary suppression to prevent premature luteinizing hormone (LH) surges. Despite its extensive clinical use, real-world evidence on its safety in large populations remains scarce. This study aimed to evaluate the safety profile of ganirelix by comprehensively analyzing adverse drug events (ADEs) using real-world data from the U.S. Food and Drug Administration Adverse Event Reporting System (FAERS) and the Japan Adverse Drug Event Reporting (JADER) database.

METHODS

We extracted ADE data from FAERS (Q1 2004-Q2 2024) and JADER (Q1 2009-Q1 2024). Disproportionality analyses, including reporting odds ratios (ROR), proportional reporting ratios (PRR), Bayesian Confidence Propagation Neural Networks (BCPNN), and Multi-item Gamma Poisson Shrinkage (MGPS), were employed to identify significant associations between ganirelix and ADEs.

RESULTS

In the FAERS database, we identified 1,096 ganirelix-related ADE reports, spanning 26 system organ classes (SOCs). A total of 65 positive signals were detected, including ADEs consistent with drug label such as ovarian hyperstimulation syndrome (OHSS) (n = 290, ROR 2462.76, PRR 2168.48, EBGM05 1655.59, IC025 9.18), injection site pain (n = 54, ROR 3.99, PRR 3.93, EBGM05 3.13, IC025 0.31), and fetal death (n = 6, ROR 21.05, PRR 21.00, EBGM05 10.72, IC025 2.72). Additionally, unexpected signals not listed in the drug label were identified, including ectopic pregnancy (n = 7, ROR 33.02, PRR 32.93, EBGM05 17.64, IC025 3.37), maternal exposure before pregnancy (n = 30, ROR 76.09, PRR 75.16, EBGM05 74.72, IC025 6.22), dermatitis allergic (n = 4, ROR 7.98, PRR 7.97, EBGM05 3.50, IC025 1.33), and bladder tamponade (n = 4, ROR 771.47, PRR 770.3, EBGM05 311.57, IC025 7.80). The median time to ADE onset was 13 days. External validation using the JADER database (62 ganirelix-related ADE reports) confirmed four signals, including abortion (n = 19), OHSS (n = 17), missed abortion (n = 9), and fetal death (n = 8), aligning with FAERS findings.

CONCLUSION

This study provides a robust real-world safety evaluation of ganirelix, with findings corroborated by two independent pharmacovigilance databases. While consistent with clinical observations, the identification of unexpected signals warrants further pharmacoepidemiological investigations to confirm these results.

Prospective, randomized, comparative study of leuprorelin + human menopausal gonadotropins versus ganirelix + recombinant follicle-stimulating hormone in oocyte donors and pregnancy rates among the corresponding recipients

AIM

To compare the clinical pregnancy rate in recipients of oocytes from donors treated with leuprorelin + human menopausal gonadotropins (hMG) with that obtained when the donors were treated with ganirelix + recombinant follicle-stimulating hormone (rFSH). The secondary aim was to compare the donors' response to the two treatments.

METHOD

A prospective, randomized, comparative study was conducted between January 2005 and November 2006 in a private hospital. Donors were randomized to receive a long protocol of leuprorelin + hMG (group DI) or ganirelix + rFSH (group DII). Their respective recipients were randomized to group RI or group RII, respectively.

RESULTS

The characteristics of the donors were similar in both groups. More cycles were cancelled in group DI than in group DII (28.1% vs. 2.5%; p < 0.05). Compared with donors in group DII, the donors in group DI required a significantly higher dose of gonadotropins (2794 +/- 957 U vs. 1777 +/- 1043 U; p < 0.05) and more days of stimulation (11.7 +/- 2.3 vs. 9.5 +/- 1.5; p < 0.05); they also yielded fewer oocytes (15.0 +/- 6.1 vs. 17.9 +/- 8.6; p < 0.05). There were no differences in the characteristics of the recipients, in the fertilization rate or in the number of embryos transferred. The quality of transferred embryos was better in group RI (8.0 +/- 1.2 vs. 7.5 +/- 1.6; p < 0.05), and this group also achieved a better pregnancy rate per embryo transfer than did group RII (62.3% vs. 48.4%; p < 0.05).

CONCLUSIONS

Treating oocyte donors with leuprorelin + hMG produces among recipients a greater probability of clinical pregnancy per embryo transfer than when donors are treated with ganirelix + rFSH; however, more cycles are cancelled and the former treatment is more unpleasant for donors.

Cryopreserved blastocyst transfer: impact of gonadotropin-releasing hormone agonist versus antagonist in the previous oocyte retrieval cycles

OBJECTIVE

To assess any detrimental effect of gonadotropin-releasing hormone (GnRH) antagonists on oocyte quality and embryo development by comparing the outcome of cryopreserved-thawed blastocyst transfers for cycles using a GnRH agonist or GnRH antagonist protocol for the controlled ovarian stimulation in the oocyte retrieval cycle.

DESIGN

Retrospective comparative study.

SETTING

Private IVF center.

PATIENT(S)

Seventy-seven women who underwent cryopreserved-thawed blastocyst transfer.

INTERVENTION(S)

The patients were divided into two groups based on whether they had been treated using a GnRH agonist long protocol (n = 44) or a GnRH antagonist multiple-dose protocol (n = 33) during the previous oocyte retrieval cycle. Cryopreserved-thawed blastocysts were transferred after endometrial preparation without pituitary suppression using a GnRH agonist.

MAIN OUTCOME MEASURE(S)

Implantation and clinical pregnancy rates.

RESULT(S)

The postthaw survival rate and numbers of good quality blastocysts transferred were similar for the GnRH agonist and GnRH antagonist groups. Implantation and pregnancy rates for cryopreserved-thawed blastocyst transfer for the GnRH agonist group versus the GnRH antagonist group were 21.0% (25 of 119) versus 29.0% (27 of 93) and 38.6% (17 of 44) versus 51.5% (17 of 33), respectively, which was not statistically significantly different.

CONCLUSION(S)

No difference was found in terms of implantation and pregnancy rates when a GnRH agonist or GnRH antagonist was used in the previous oocyte retrieval cycle. Our results suggest that GnRH antagonists do not have a detrimental effect on oocyte quality or embryo development.

Triggering ovulation with gonadotropin-releasing hormone agonists does not compromise embryo implantation rates

OBJECTIVE

To evaluate the implant capacity of embryos derived from oocytes matured with a bolus of GnRH agonist.

DESIGN

Donors were randomly assigned to a protocol using either GnRH agonist or recombinant (r) hCG to trigger ovulation. Analysis of variance, Student t test, and Fisher exact test were used where appropriate.

SETTING

Private clinical setting.

PATIENT(S)

Young voluntary donors receiving GnRH agonist (n = 30) or rhCG (n = 30). Eighty-nine patients received oocytes.

INTERVENTION(S)

Controlled ovarian stimulation was carried out with GnRH antagonist and FSH/LH in a step-down protocol. Donors received a single bolus of GnRH agonist (0.2 mg) or rhCG (250 microg). The endometrial tissue of recipient patients was prepared with oral E(2) and P.

MAIN OUTCOME MEASURE(S)

Pregnancy and implantation rates and ovarian hyperstimulation syndrome (OHSS) in an IVF donor program.

RESULT(S)

No significant differences in the number of retrieved oocytes (327 vs. 288), MII oocytes (70% vs. 76%), fertilization (80% vs. 65%,), pregnancy/transfer (55% vs. 59%), and implantation rates (29% vs. 32%) were found between recipients whose embryos originated from donors in whom final oocyte maturation was triggered with GnRH agonist and those whose donors received hCG. Significant differences in luteal phase length (4.16 + 0.70 days vs. 13.63 + 2.12 days) and in OHSS (0/30 vs. 5/30) were seen between donors ovulated with the agonist and the donors in whom ovulation was triggered with hCG.

CONCLUSION(S)

In controlled ovarian stimulation IVF donor cycles, GnRH agonists trigger ovulation and induce luteolysis but do not compromise embryo implantation capacity.

GnRH agonist versus GnRH antagonist in oocyte donation cycles: a prospective randomized study

BACKGROUND

The specific role of LH in folliculogenesis and oocyte maturation is unclear. GnRH antagonists, when administered in the late follicular phase, induce a sharp decrease in serum LH which may be detrimental for IVF outcome. This study was performed to evaluate whether the replacement of GnRH agonist (triptorelin) by a GnRH antagonist (ganirelix; NV Organon) in oocyte donation cycles has any impact on pregnancy and implantation rates.

METHODS

A total of 148 donor IVF cycles was randomly assigned to use either a GnRH antagonist daily administered from the 8th day of stimulation (group I) or a GnRH agonist long protocol (group II) for the ovarian stimulation of their donors. The primary endpoints were the pregnancy and the implantation rates.

RESULTS

The clinical pregnancy rate per transfer (39.72%, 29/73 versus 41.33%, 31/75) based on transvaginal scan findings at 7 weeks of gestation, the implantation rate (23.9 versus 25.4%) and the first trimester abortion rate (10.34 versus 12.90%) were similar in the two groups.

CONCLUSION

In oocyte donation cycles the replacement of GnRH agonist by a GnRH antagonist appears to have no impact on the pregnancy and implantation rates when its administration starts on day 8 of stimulation.

Vascular endothelial growth factor and inhibin A in follicular fluid of infertile patients who underwent in vitro fertilization with a gonadotropin-releasing hormone antagonist

OBJECTIVE

To investigate the role of a gonadotropin-releasing hormone (GnRH) antagonist, minimal stimulation protocol, in the follicular fluid by measuring vascular endothelial growth factor (VEGF) and inhibin A.

DESIGN

A cross-sectional prospective study.

SETTING

Academic hospital.

PATIENT(S)

Seventy infertile patients submitted to in vitro fertilization (IVF).

INTERVENTION(S)

Patients were divided into two groups: group 1 (study) included 30 infertile patients subjected to IVF with a GnRH antagonist (minimal stimulation protocol); group 2 (control) included 40 infertile women who underwent natural-cycle IVF.

MAIN OUTCOME MEASURE(S)

Follicular fluid VEGF and inhibin A measurements.

RESULT(S)

The groups were comparable in terms of age, body mass index (BMI), and infertility characteristics. Moreover, follicular fluid VEGF and inhibin A concentrations (medians) were, respectively, 776 pg/ml (95% confidence interval [CI]: 775-1483) and 3,115 pg/mL (95% CI: 1,349-2,502) for group 1; 1,187.50 pg/mL (95% CI: 1,020-1,560) and 3,123.00 pg/mL (95% CI: 1,888-2,735) for group 2 (P>.05).

CONCLUSION(S)

We demonstrated that GnRH antagonist administration in infertile patients undergoing IVF did not alter the follicular fluid content of VEGF and inhibin A, and, probably, maturation and quality of oocytes as well. These results demonstrated the usefulness and safety of this drug on controlled ovarian stimulation (COS) protocols.

Timing ovulation for intrauterine insemination with a GnRH antagonist

BACKGROUND

We aimed to assess the efficacy of a GnRH antagonist in intrauterine insemination (IUI) cycles to increase number of mature ovulatory follicles and pregnancy rates.

METHODS

Prospective randomized study. Women (18-38 years old) with primary/secondary infertility were included. Eighty-two patients were randomly assigned to controlled ovarian stimulation (COS) consisting of rFSH + GnRH antagonist or rFSH alone.

RESULTS

A non-significant increase in the total amount of rFSH was seen in the GnRH antagonist group (707+/-240 IU) with respect to the control group (657+/-194 IU). The number of mature follicles (> or =16 mm) was significantly higher in the GnRH antagonist group than in the control group (2.4+/-1.4 versus 1.7+/-1.2, P<0.05). Pregnancy rates were significantly increased in the group of patients receiving the GnRH antagonist (38%) compared to the control group (14%). The only non-single pregnancy (triplets) occurred in the antagonist group.

CONCLUSIONS

In this preliminary study, adding the GnRH antagonist to the COS protocol for IUI cycles significantly increased pregnancy rates. Nevertheless, these results may not be associated directly with the antagonist itself but with the fact that more mature ovulatory follicles are present by the day of the hCG. Finally, the risk for multiple gestations needs to be carefully evaluated.

Luteinizing hormone supplementation increases pregnancy rates in gonadotropin-releasing hormone antagonist donor cycles

OBJECTIVE

To determine whether LH supplementation improved pregnancy and implantation rates in GnRH antagonist donor cycles.

DESIGN

Donors were randomly assigned to a protocol using GnRH antagonist (GnRH-a) alone or GnRH-a + recombinant LH. Analysis of variance, Student's t-test and Fisher's exact test were used where appropriate.

SETTING

Private clinical setting.

PATIENT(S)

Young voluntary donors with antagonist (n = 20) and antagonist + LH (n = 22). Fifty-five patients received oocytes.

INTERVENTION(S)

Donors received the GnRH-a (Cetrorelix, 0.25 mg/day) alone or in combination with recombinant LH (75 IU/day). Ovulation induction was carried out with recombinant FSH in a step-down protocol. The endometrial tissue of recipient patients was prepared with oral E(2) and P.

MAIN OUTCOME MEASURE(S)

Pregnancy and implantation rates in a donor program.

RESULT(S)

A significant increase in MII oocyte (80% vs. 71%), fertilization rates (83% vs. 71%), G1 embryos (17% vs. 3%), and implantation rates (35% vs. 15%), were found in recipients whose embryos originated from donors receiving GnRH-a + recombinant LH as compared to donors receiving GnRH-a alone. Estradiol levels, pregnancy/transfer and clinical pregnancies were lower (not significant) in donors treated with the GnRH-a alone vs. those receiving the recombinant LH-supplemented GnRH-a.

CONCLUSION(S)

The LH supplementation improved the possibilities of gestation for recipients whose embryos originated from GnRH-a-treated donors.