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Human Reproduction, Vol. 15, No. 9, 1881-1882, September 2000
© 2000 European Society of Human Reproduction and Embryology

Debates Continued

Embryo implantation and GnRH antagonists

GnRH antagonists in ART: lower embryo implantation?

Shahar Kol

Department of Obstetrics and Gynecology, Rambam Medical Center, Haifa, Israel

Abstract

Recently, concerns have been raised regarding possible adverse effects of gonadotrophin-releasing hormone (GnRH) antagonists on extra-pituitary reproductive cells and organs, i.e. ovarian cells, oocyte, embryo, endometrium. These concerns are based on numerous in-vitro studies suggesting decreased biosysnthesis of growth factors caused by local action of GnRH antagonists. Clinically, it has been shown that the use of high doses (<=1 mg daily) of GnRH antagonists is associated with low implantation rates in IVF. Although such direct adverse effect of GnRH antagonists cannot be ruled out at this time, so far clinical experience points to profound LH suppression as the major caveat associated with the use of high doses of GnRH antagonists. Very low LH concentrations are associated with aberrant concentrations of oestradiol during ovarian stimulation, which may in turn adversely effect implantation potential. The clinical data available thus far on the use of GnRH antagonists originate from protocols designed for clinical studies. It is predicted that as more clinical experience is gained, and with protocol modifications to suit individual patient response, GnRH antagonists will be comparable with the agonists in terms of cycle outcome.

Key words: ART/GnRH antagonists/implantation rates

Notes

To whom correspondence should be addressed at: Department of Obstetrics and Gynecology, Rambam Medical Center, Haifa, Israel. E-mail: skol{at}rambam.health.gov.il

This debate was previously published on Webtrack, June 12, 2000


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