Copenhagen, Denmark 19 - 22 June 2005

GnRH agonists before IVF in endometriosis: a meta analysis H Sallam [1], JA Garcia-Velasco [2], A Arici [3] [1] Alexandria University Obstetrics and Gynaecology Alexandria, Egypt [2] Instituto Valenciano de Infertilidad Rey Juan Carlos University Madrid, Spain [3] Yale University School of Medicine Division of Reproductive Endocrinology New Haven, CT, USA

Introduction
Patients with endometriosis treated with IVF and ICSI have a lower pregnancy rate compared with women having tubal factor infertility. It has been suggested that the administration of GnRH agonists for a few months prior to IVF or ICSI increases the pregnancy rate in these women. However, the results of different studies have not been consistent.

The aim of this study was to evaluate the effectiveness of administering GnRH agonists for 3 to 6 months prior to IVF or ICSI in women with endometriosis by conducting a metaanalysis of randomized controlled trials (RCTs).

Materials and methods
We conducted computer searches of the MEDLINE and EMBASE databases and sought references from the Cochrane Central Register of Controlled Trials (CENTRAL), the National Research Register (NRR) and the MDSG specialized register of controlled trials.

We hand searched proceedings of annual meetings of ASRM and ESHRE, reviewed lists of references in original research and review articles and contacted experts in various countries to identify unpublished trials. In our meta-analysis, we included RCTs using any GnRH agonist prior to IVF/ICSI to treat women with any degree of endometriosis diagnosed by laparoscopy or laparotomy.

The data were extracted independently by two reviewers (H.N.S. and J.G.V.) and assessed for validity. Any disagreement was resolved by arbitration with the third reviewer (A.A.). We generated 2·2 tables for principal outcome measures. The Peto-modified Mantel–Haenszel technique was used to calculate
odds ratios and assess statistical heterogeneity between studies.

Results
Our meta-analysis showed that the live birth rate per woman was significantly higher in patients receiving GnRH agonist compared with the control group (OR=4.74, 95% CI=1.64–13.63). The clinical pregnancy rate per woman was also significantly higher (OR=4.28, 95% CI=2.00–9.15).

There was no significant difference in the number of oocytes retrieved or in the dose of HMG or FSH required by patients in the study group compared with the control. There was no heterogeneity between the studies included in the Meta-analysis.

Conclusions
The administration of GnRH agonists for a period of 3–6 months prior to IVF or ICSI in patients with endometriosis increases the clinical pregnancy rate and the live birth rate significantly.

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