The efficacy of gonadotropin-releasing hormone (GNRH) agonist before frozen embryo transfer in improving pregnancy outcome and decreasing miscarriage rate in hyperandrogenic polycystic ovary syndrome women: a randomized clinical trial.

BACKGROUND The hyper androgenic status is a major complication of PCOS women that deteriorates endometrial function and increases miscarriage rate. OBJECTIVE This study was conducted to investigate the efficacy of GnRH agonist before frozenthawed embryo transfer in improving pregnancy outcome in infertile women with PCOS. MATERIALS & METHODS This single-blind, randomized controlled trial was performed at Dr Shariati hospital and Omid Fertility Clinic in Tehran, Iran. To do the study, 178 PCOS women were included. Patients were then divided into two groups of control and intervention. All women received the standard treatment for the preparation of the endometrial using estradiol valerate at dose of 6-8 mg/day. The intervention group also received diphereline, as GnRH agonist, at two doses 8 weeks before starting the endometrial preparation. RESULTS Chemical pregnancy in intervention group was 47.7% compared to 35.6% in the control group, revealing no significant difference between two groups. No statistically significant difference was observed between two groups concerning clinical pregnancy rate (43.2%vs. 27.3%). However, rate of ongoing pregnancy was42.0% in intervention group but18.0% in thecontrol group, suggesting a significant difference (p =0.001). The rate of miscarriage in the intervention group was 2.6% and in the control group was 33.3% which was significantly lower (p = 0.001). CONCLUSIONS It can be concluded that endometrial preparation using GnRH improves ongoing pregnancy and decreases miscarriage rate. It seems that reduction of androgen level in PCOS patients affects the endometrium and improves the re resulting in better pregnancy outcomes by reducing the miscarriage rate.