Oral GnRH Antagonist a Less Invasive, Cheaper Alternative to Injectables in IVF

NEW ORLEANS — Off-label use of oral elagolix (Orilissa) may be a more patient-friendly alternative to standard-of-care injectable GnRH antagonists for ovulation suppression during in vitro fertilization (IVF), according to a retrospective study.

From before use of the GnRH antagonist to the day after intake, serum luteinizing hormone (LH) levels dropped 22% in the injectable group compared with 42% in the elagolix group, which was not a statistically significant difference, reported Marco Mouanness, MD, of the Rejuvenating Fertility Center in New York City, during a presentation at the American Society for Reproductive Medicine (ASRM) annual meeting.

Estradiol levels increased by 74% in the injectable group compared with 111% in the elagolix group. There was only one breakthrough ovulation in either group, and the number of oocytes collected was similar between the elagolix and injectable groups (8 vs 5).

While injectable forms of GnRH antagonists are the standard for ovulation suppression in IVF, they need to be dosed daily and can be painful and expensive, with a single dose ranging from $125 to $175. Elagolix comes in an oral form, is taken every other day, and the 50-mg pill is only $19.

“Oral GnRH antagonists, like elagolix, are much cheaper and less invasive medication used at a lower frequency — every other day compared to daily — showing variable ovulation suppression to the costly injectable GnRH antagonists with comparable cycle outcomes,” Mouanness said.

Morine Cebert, MSN, PhD, of Yale New Haven Health System in Bridgeport, Connecticut, told MedPage Today that having a cheaper alternative like elagolix could open up fertility treatment to people with lower incomes.

“As we think of access to care and trying to get more people into fertility from all groups, we want to reduce the cost, but the technology is expensive,” Cebert said.

Cutting costs wherever possible could potentially make treatments like IVF accessible to more people, she noted. “Overall, it would help with improving access to care, which has been really important.”

Elagolix is approved for treating endometriosis-associated pain, but had not been studied for ovulation suppression in autologous-IVF cycles.

This retrospective study took place from January to September 2023 at the university-affiliated fertility center where the authors work. Participants needed to be undergoing gentle simulation IVF using antagonist protocol, be less than 42 years old, and have follicle-stimulating hormone levels less than 15 IU/L.

There were 59 patients in the elagolix group and 20 patients in the injectable group (ganirelix or cetrorelix 125 mcg). Medication was given once the dominant follicle reached 13 mm and was based on patient preference, health insurance coverage, and affordability to the patient. Age and body mass index were similar between groups.

In total, 121 pre- and post-LH values were collected, with 91 in the elagolix group and 24 in the injectable group.

Mouanness noted that the retrospective nature of the study is inherently a limitation. Additionally, the choice of medication was influenced by each patient’s preference, budget, and what their health insurance covered. The team is continuing their research by looking at dose responses, pregnancy rates and outcomes, and endometrial receptivity.

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