The Role of GnRH Analogues in Improving Outcome in Women Undergoing Superovulation and Intrauterine Insemination after Surgical Correction of Mild Endometriosis: A Randomized Controlled Trial

Abstract

Objective: Treatment with laparoscopic surgery, gonadotropin-releasing hormone analog (GnRHa) therapy,superovulation (SO), and intrauterine insemination (IUI) have individual benefits in improving fertility outcomesin women with endometriosis. The aim of the study was to evaluate the role of GnRHa in improvingoutcome in women undergoing SO and IUI after surgical correction of mild endometriosis.Materials and Methods: This was a randomized controlled trial conducted in the Department of Obstetricsand Gynecology, All India Institute of Medical Sciences, New Delhi, India, over a period of 2 years and6 months. Ninety women who were diagnosed with mild endometriosis on laparoscopy using the revisedAmerican Society for Reproductive Medicine criteria were included in the study. The patients in the studygroup (n=45) received a single dose of 3.75 mg GnRHa subcutaneously within 48 h of the surgery, and thosein the control group (n=45) did not receive GnRHa. Thereafter, patients in both arms received SO and IUIfrom the next menstrual cycle. Four patients in the study group and three patients in the control group werelost to follow-up before the first cycle of ovulation induction. Primary outcomes measured in our study werelive birth rates and clinical pregnancy rate. Secondary outcome measures were number of follicles>18 mm,endometrial thickness, dose and days of gonadotropin stimulation.Results: Baseline characteristics, such as age and body mass index, were comparable in both groups. The SOand IUI cycles were comparable between the two groups with regard to the secondary outcome parameters.Pregnancy rate in the first cycle was 17.1% in the study group and 19.1% in the control group (p=0.81). Theoverall pregnancy rate was similar in both groups (study group=21.9%, control group=23.8%; p=1). As nopatient had miscarriage or any other complication during pregnancy, live birth rate was similar to the clinicalpregnancy rate.Conclusion: Adding GnRHa for the suppression of mild endometriosis has shown no significant improvementin the surgical management of women undergoing SO and IUI.