Elagolix as an oral substitute for injectable GnRH antagonists in IVF: a review and recent developments

Abstract

During controlled ovarian stimulation for in vitro fertilization (IVF), a luteinizing hormone (LH) surge can trigger the release of a premature oocyte before scheduled oocyte retrieval. Suppressing this surge is critical in order to achieve a successful round of IVF. Gonadotropin Releasing Hormone (GnRH) antagonists bind to the GnRH receptor in the pituitary gland and prevent endogenous GnRH from stimulating LH release. This is a rapid and reversible blockade used by clinicians to enable successful IVF outcomes. Traditionally, injectable antagonist agents like ganirelix/cetrorelix have been popular but are reported as painful and expensive. Recently, new literature regarding the use of elagolix, an oral non-peptide GnRH antagonist, as a potentially less invasive and cheaper alternative has been published. This review critically appraises the present evidence on elagolix as an oral alternative for LH surge suppression in IVF. A literature search was conducted using PubMed as the primary database, supplemented by Google Scholar to identify additional relevant sources. Search terms included combinations of phrases like “elagolix,” “IVF,” “GnRH antagonist,” “ovarian stimulation,” “ganirelix,” “cetrorelix,” “HPO axis.” Studies were included if they reported original data or reviewed existing evidence on GnRH antagonist use in the context of ovarian stimulation for IVF. Studies examining elagolix’s use in the management of endometriosis-associated pain were also included. Reference lists of identified studies were further reviewed to pull additional relevant information. This search yielded additional studies that met the inclusion criteria. Across the available studies, elagolix demonstrates comparable LH suppression to injectable GnRH antagonists, offering a reduced injection and per-cycle cost burden for IVF patients. However, this evidence is limited to a small number of majorly retrospective and a few prospective cohort studies. No randomized controlled trials have been published to date. Dosage and safety data relevant to elagolix’s use in IVF also remains scarce. According to our analysis, elagolix shows promise, but larger clinical trials and prospective studies are needed to solidify elagolix as a cost-effective and hypoalgesic alternative.