Human Reproduction, Vol. 15, No. 6, 1211-1216,
June 2000
© 2000 European Society of Human Reproduction and Embryology
Embryo implantation and GnRH antagonists
Embryo implantation: the Rubicon for GnRH antagonists
Clinica de Reproduccion Asistida FIV-Madrid and Instituto de Bioquimica (CSIC-UCM), C/Alvarez de Baena 4, 28006 Madrid, Spain. E-mail: ehernandezm{at}meditex.es
When gonadotrophin-releasing hormone (GnRH) was discovered, the agonist and antagonist of GnRH were developed to control the release of FSH and LH by the gonadotrophs. More than 10 years of research were needed to develop a GnRH antagonist free of histamine release. Recent studies have shown that these GnRH antagonists are effective in preventing a rise in LH during ovarian stimulation in IVF. However, a decrease in ongoing pregnancies seems to suggest that implantation rates per transferred embryo are reduced in GnRH antagonist-stimulated cycles. In my opinion, these data highlight an area less well known to clinicians: the role of the GnRH antagonist at the cellular level in extrapituitary tissues. There are sufficient data in the literature suggesting that GnRH antagonist is an inhibitor of the cell cycle by decreasing the synthesis of growth factors. Given that, for folliculogenesis, blastomere formation and endometrium development, mitosis is everything; the interaction between the GnRH antagonist and the GnRH receptor (present in all these cells and tissues) may compromise the mitotic programme of these cells. This is the Rubicon for the GnRH antagonist: to demonstrate irrevocably that, at the minimal doses necessary to suppress LH release, it does not affect processes such as implantation, embryo development and folliculogenesis.
Key words: embryo implantation/GnRH agonists/GnRH antagonists
This debate was previously published on Webtrack, April 4, 2000
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