Abstract: Background: Endometriosis, a chronic gynecological condition affecting reproductive-age women, is strongly associated with infertility. Gonadotropin-releasing hormone agonists (GnRH-a) are widely used for endometriosis management and may improve outcomes in assisted reproductive technology (ART). This study to assess the reproductive outcomes of endometriosis patients undergoing controlled ovarian stimulation and ICSI cycles with two treatment regimens: GnRH agonists and combined oral contraceptives (COCs).
Methods: It is a prospective study conducted from March 2020 to March 2024. A total of 100 patients with stage I–IV endometriosis were randomly assigned to two treatment groups: a GnRH agonist group (N=50) and a combined oral contraceptive (COC) group (N=50). Clinical, hormonal, and reproductive parameters were assessed and compared between the groups.
Results: The GnRH agonist group demonstrated superior reproductive outcomes compared to the COC’s group, with higher clinical pregnancy rates (76% vs. 72%), ongoing pregnancy rates (68% vs. 56%), and cumulative live birth rate per patient (50% vs. 46% for stage I–II and 40% vs. 38% for stage III–IV). Although the GnRH agonist group required higher gonadotropin doses, they exhibited improved embryo quality and implantation success. Additionally, miscarriage rates were lower in the GnRH agonist group (6% vs. 12%) compared to COC’s group
Conclusion: Both regimens were effective in enhancing reproductive outcomes, however, the GnRH agonist protocol was associated with higher clinical pregnancy and live birth rates, particularly in patients with advanced-stage endometriosis. The administration of GnRH agonists in patients with varying stages of endometriosis may enhance ICSI outcomes compared to the COC protocol. Optimizing treatment strategies is essential to improving reproductive outcomes in endometriosis-associated infertility. These findings highlight the importance of tailored treatment protocols to enhance reproductive success in endometriosis patients undergoing ART.
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