Gonadotrophin-releasing hormone agonists in assisted reproductive therapy

Gonadotrophin-releasing hormone agonists (GnRHa) play a critical role in assisted conception therapy today, The use of the long protocol of GnRHa administration to desensitize the pituitary gland before gonadotrophins are administered increases pregnancy and livebirth rates after IVF and allows the timing of human chorionic gonadotrophin administration to be made much more flexible, This allows IVF treatment to be simplified because the degree of monitoring of ovarian stimulation can be minimized. This has tremendous advantages to the patient and the IVF programme, and promotes the concept that IVF today should be considered as multiple cycle therapy, This concept is fundamentally important because, for most patients, the best way they can achieve ultimate success is for them to undertake repeated treatment cycles, Finally, there are some data which suggest that women with polycystic ovarian syndrome have a higher risk of miscarriage which can be normalized by pituitary desensitization before the administration of gonadotrophins. Because of the medical and practical advantages conferred by the use of GnRHa, serious consideration should be given to the routine use of the long protocol for ovarian stimulation in assisted conception today.