Does Gonadotropin-Releasing Hormone Agonist Administration Before Assisted Reproduction Techniques Improve Pregnancy Rates in Women With Endometriosis?

ABSTRACT Importance Axial downregulation with a 3- to 6-month administration of gonadotropin-releasing hormone agonists (GnRH-a) prior to assisted reproduction techniques has been proposed in order to improve clinical pregnancy rates in women with endometriosis. Although reduced inflammation, improved oocyte quality, and restored endometrial receptivity have been postulated, further investigation of their actual benefit and mechanism of action is considered essential. In that direction, well-designed clinical trials regarding the role of GnRH-a in IVF are necessary. Objective The purpose of this review is to clarify whether GnRH-a administration prior to IVF-FET procedures improves pregnancy rates in women with endometriosis. Evidence Acquisition A literature review was conducted in MEDLINE (PubMed), Cochrane, and Google Scholar and concluded on September 10, 2022. Results Two Cochrane meta-analyses and 16 selected studies present various interesting data of assisted reproduction technique procedures on patients with endometriosis-related infertility with or without depot GnRH-a pretreatment. Conclusions The regimen may have a positive clinical effect on cases of severe endometriosis (American Society for Reproductive Medicine stages III–IV), but their use is not routinely recommended in order to improve pregnancy rates. Relevance Endometriosis and infertility are closely related through various pathogenetic mechanisms. Endometriosis has been traditionally considered to negatively affect fundamental aspects of the in vitro fertilization–frozen embryo transfer procedure. Numerous interventions, both medical and surgical, have been proposed in order to improve IVF success rates, and the optimal management of these cases poses an ever pressing challenge. Target audience Obstetricians and gynecologists, family physicians Learning objectives After completing this activity, the learner will be better able to describe the relationship between endometriosis and infertility, including implication of assisted reproduction techniques; discuss the role of GnRH-a pretreatment in IVF-FET procedures, in terms of results and underlying mechanism of action; and explain limitations of existing data and the need for further research.