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Objective
To use microarray technology to analyze endometrial gene expression after gonadotropin-releasing hormone agonist (GnRH-a) triggering with four different protocols of luteal support in comparison with results obtained after a human chorionic gonadotropin (hCG) trigger.
Design
Prospective, randomized, controlled trial.
Setting
University-affiliated private assisted-reproduction center.
Patient(s)
25 healthy oocyte donors undergoing controlled ovarian stimulation.
Intervention(s)
On day of final oocyte maturation, randomization to [1] GnRH-agonist triggering and luteal support with oral estradiol (2 mg/8 hours) and vaginal progesterone (200 mg/12 hours), [2] GnRH-a and a daily dose of 150 IU of recombinant LH from oocyte pickup, [3] GnRH-a and a single bolus of 60 渭g of recombinant hCG on oocyte pickup, [4] GnRH-a and three doses of 20 渭g of recombinant hCG separated by 48 hours, or [5] 250 渭g of recombinant hCG for trigger and standard luteal support; with endometrial biopsy samples collected 7 days after triggering.
Main Outcome Measure(s)
Gene expression using the Endometrial Receptivity Array (ERA) and pathway and network analysis of study groups 1-4 compared with controls (group 5).
Result(s)
The 56 genes in group 1 (25 up-regulated and 31 down-regulated) exhibited altered expression compared with the 36 genes from group 2 (13 up-regulated and 23 down-regulated), 44 from group 3 (28 up-regulated and 16 down-regulated), and 30 (20 up-regulated and 10 down-regulated) from group聽4.
Conclusion(s)
Differences were seen in endometrial gene expression related to the type of ovulation trigger and luteal support. However, gene expression after the GnRH-a trigger and modified luteal support adding LH/hCG activity more closely resembles the pattern seen in the hCG group.
Clinical Trial Registration Number
EudraCT 2011-003250-34.
