The present stud was designed to assess the usefulness of the ultralong protocol of gonadotropin-releasing hormone agonist(GnRH-a) for superovulation with intrauterine insemination(IUI) in patients with various stage of endometriosis. A
prospective
randomized trial was set up to compared the ultralong and long protocols of GnRH-a for superovulation with IUI in patients with endometriosis. There was no evidence of other factors in infertility in any patient. In the ultralong protocol(28
patients),
a delayed release preparation of GnRH-a was administered once intramuscularly at the midluteal phase of menstrual cycle, Four weeks after administration of delayed release preparation of GnRH-a, daily subcutaneous administration of GnRH-a was
initiated
and protracted at a dose of 0.1mg/d for at least 2 weeks prior to superovulation along with exogenous gonadotropin. In the long protocol(41 patients), daily subcutaneous administration of GnRH-a was initiated at a dose of 0.1mg/d from the
midluteal
phase and exogenous gonadotropin was commenced after pituitary desensitization. Daily GnRH-a injections were continued at the same dose until the day of human chorionic gonadotropin (hCGT). The amount of gonadotropin required, days of
gonadotropin
administration, serum estradiol response, and the number of mature follicles are comparable in both groups. A clinical pregnancy rate per cycle was significantly higher in ultralong protocol group, with 50.0% (14/28) compared with 26.8%(11/14) in
long
protocol group. The miscarriage rate was 14.3%(2/14) in the ultralong protocol group and 18.2%(2/11) in the long protocol group. In patients with stage I or II endometriosis, there was no significant difference between two groups in a clinical
pregnancy
rate per cycle(46.2% vs 35.0%). In patients with stage III or IV endometriosis, a clinical pregnancy rate per cycle was significantly higher in ultralong protocol group, with 53.3%(8/15) compared with 19.0%(4./12) in long protocol group. This
study
suggests that an ultralong protocol of GnRH-a could give better chances of success in endometriosis patients undergoing assisted reproductive technologies and this protocol may be more useful in patients with advanced stage of endometriosis.
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