Hum. Reprod. Advance Access originally published online on March 11, 2004
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Human Reproduction, Vol. 19, No. 4, 874-879,
April 2004
© 2004 European Society of Human Reproduction and Embryology
Pituitary suppression in ultrasound-monitored frozen embryo replacement cycles. A randomised study
1 Assisted Conception Unit, Guy’s and St. Thomas’ Hospital NHS Trust, and 2 Department of Women’s Health, Guy’s, King’s and St. Thomas’ School of Medicine, St. Thomas Street, London SE1 9RT, UK.
3 Corresponding author at: Assisted Conception Unit, 4th Floor Thomas Guy House, Guy’s Hospital, St. Thomas Street, London SE1 9RT, UK. Tel.: 0207 955 5000 ext 3977; Fax: 0207 955 4430; e-mail: tarekeltoukhy{at}hotmail.com
BACKGROUND: This study was designed to assess the value of using a gonadotrophin-releasing hormone (GnRH) agonist prior to exogenous steroid supplementation for endometrial preparation in frozen-thawed embryo replacement (FER) cycles. METHODS: A prospective randomized trial of 234 patients undergoing FER cycles was conducted. The study population was randomly divided into two groups according to a computer-generated list. In group A (n = 117), a daily dose of 6 mg of oral estradiol valerate was initiated on menstrual day 1 following pituitary suppression using 400 mcg buserelin acetate daily. In group B (n = 117), the same dose of estradiol valerate was initiated on day 1 of bleeding without prior GnRH agonist therapy. In both groups, ovulation monitoring was not undertaken and progesterone pessaries (800 mg daily) were administrated when the endometrial thickness had reached 8 mm or more with embryo transfer taking place 2 days later. RESULTS: The two groups were comparable with respect to cause of infertility, age at stimulation (32.8 ± 4 vs 33.2 ± 3.9 years, P = 0.4), basal FSH level (6.3 ± 1.7 vs 6.4 ± 2 IU/l, P = 0.5), number of oocytes collected (16.9 ± 7.3 vs 16.5 ± 7.4, P = 0.7) and fertilized normally in the retrieval cycle (11.5 ± 4.9 vs 11 ± 4.9, P = 0.4) and number of embryos cryopreserved (6.6 ± 3.6 vs 6.2 ± 3.6, P = 0.3). There was no significant difference between the two groups in age at frozen replacement (33.6 ± 4.2 vs 34 ± 3.9 years, P = 0.4), duration of the proliferative phase (20.7 ± 8.6 vs 21 ± 9.2 days, P = 0.7) and number of thawed embryos replaced (2.3 ± 0.6 vs 2.2 ± 0.6, P = 0.2). However, compared with group B, group A achieved significantly higher pregnancy (37.6% vs 24%, OR 1.8, 95%CI 1.1–3.4), clinical pregnancy (24% vs 11.3%, OR 2.5, 95%CI 1.2–5.5) and live birth rates (20% vs 8.5%, OR 2.9, 95%CI 1.2–8). CONCLUSION: Medicated frozen embryo replacement cycles timed by endometrial thickness measurement alone without monitoring or suppression of ovarian activity are associated with reduced outcome.
Key words: cryo-thawed cycle outcome/embryo cryopreservation/pituitary suppression
Submitted 17 December, 2003 ; accepted: 5 January, 2004
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  G. Griesinger, M. Weig, A. Schroer, K. Diedrich, and E.M. Kolibianakis Mid-cycle serum levels of endogenous LH are not associated with the likelihood of pregnancy in artificial frozen-thawed embryo transfer cycles without pituitary suppression Hum. Reprod., October 1, 2007; 22(10): 2589 - 2593. [Abstract] [Full Text] [PDF]
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