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Efficacy of GnRH agonist trigger in women having history of follicular–endometrial asynchrony with clomiphene/IUI cycles in unexplained infertility

  • Gynecologic Endocrinology and Reproductive Medicine
  • Published:
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Abstract

Purpose

An alternative option to human chorionic gonadotropin (hCG) is GnRH agonist (GnRH-a) for ovulation trigger in intrauterine insemination (IUI) cycles. This study aims to compare the efficacy of GnRH-a with hCG in women with history of follicular–endometrial asynchrony after clomiphene in IUI cycles.

Methods

This prospective observational study recruited 631 women with unexplained infertility and follicular–endometrial asynchrony (follicle ≥ 18 mm, endometrial thickness (ET) < 7 mm) in previous two failed clomiphene/IUI cycles. Overall 27 patients with synchronized follicular–endometrial relationship and 49 women with persistent ET < 7 mm and/or follicle > 26 mm were excluded. Remaining women (n = 555) were divided into two groups: Group A (n = 285) received GnRH-a and Group B (n = 270) received hCG ovulation trigger. Finally, 513 patients, who underwent IUI, were analysed.

Results

Cancellation due to luteinized unruptured follicle was more in hCG group (P = 0.01). Higher clinical pregnancies (10.33 vs. 4.96%, P = 0.03) and live birth rates (8.86 vs. 4.13%, P = 0.03) were noted with GnRH-a trigger. Miscarriage rate was comparable in both the groups (10.71 and 16.67% in Group A and Group B, respectively).

Conclusion

In unexplained infertility, GnRH agonist is an useful alternative for triggering ovulation in women with follicular–endometrial asynchrony following clomiphene induction.

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Acknowledgements

We would like to thank DR. Pratip Chakraborty for statistical help.

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Authors and Affiliations

  1. Institute of Reproductive Medicine, HB-36/A/3, Sector-III, Salt Lake City, Kolkata, 700106, India

    Shikha Bathwal, Astha Chakravarty, Sunita Sharma, Soma Singh, Indranil Saha & Baidyanath Chakravarty

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  1. Shikha Bathwal
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  2. Astha Chakravarty
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  3. Sunita Sharma
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  4. Soma Singh
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  5. Indranil Saha
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  6. Baidyanath Chakravarty
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Contributions

SB: Protocol development, data analysis, manuscript writing and editing. AC: Data collection, manuscript writing. SS: Protocol development, data analysis, manuscript writing and editing. SS: Data collection, manuscript writing. IS: Manuscript writing and editing. BC: Protocol development and manuscript editing.

Corresponding author

Correspondence to Sunita Sharma.

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The authors declare that they have no conflicts of interest.

Ethical approval

Ethical approval was obtained from the institutional review board (IRM/IEC/BNC-IHP/46).

Research involving human participants and/or animals

This article does not contain any studies with animals performed by any of the authors.

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Written informed consent was obtained from all individual participants included in the study.

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Bathwal, S., Chakravarty, A., Sharma, S. et al. Efficacy of GnRH agonist trigger in women having history of follicular–endometrial asynchrony with clomiphene/IUI cycles in unexplained infertility. Arch Gynecol Obstet 298, 427–432 (2018). https://doi.org/10.1007/s00404-018-4834-1

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  • DOI: https://doi.org/10.1007/s00404-018-4834-1

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