Introduction: Between 5±18% of patients presents a low response when stimulated for IVF cycles. The fertility of these patients could be compromized by the premature LH surge. The addition of GnRH antagonist to ovarian stimulation could prevent this eventuality, avoiding any suppression in the early follicular phase. In this multicentric, prospective study we compared two different stimulation protocols in poor responder patients undergoing IVF. Materials and methods: A total of 38 patients with a poor ovarian response in previous standard treatment (mean age 6 SD: 33.7 6 3.6 years; min = 24; max = 44),were selected on the basis of purely clinical criteria and divided into two groups: group I (n = 19) were stimulated with a ¯are-up short protocol using from day 2 of the cycle a daily dose of GnRH analogues (Triptorelina 0.1 mg/day s.c.; Decapeptyl) and 375 IU of r-FSH. Group II (n = 19) received 375 IU of r-FSH from day 2 of the cycle and daily dose of GnRH antagonist cetrorelix (Cetrotide, 0.25 mg) when two follicles had reached 14 mm of diameter until the day of HCG administration. Estradiol (E2) analysis and vaginal ultrasounds were performed to evaluate the ovarian response. In case of severe male factor, IVF was performed by ICSI. Results: On the 38 stimulated cycles we obtained the following results. (i) Mean stimulation duration (11.5 6 1.3 versus 12.0 6 1.2) and the number of ampoules (57.5 6 6.5 versus 60.0 6 6.3) used were not different between groups. (ii) Numbers, grade and quality of embryos transferred were comparable between two treatments. (iii) Fewer cycles were cancelled with the antagonist protocol (i versus iii). (iv) Three pregnancies were obtained with GnRH antagonist protocol (16.6% per embryo transfer) and two with GnRH ¯are-up agonist protocol (12.5% per embryo transfer). Conclusions: These data indicate that the use of GnRH antagonist multiple dose protocol allows the achievement of good results in terms of pregnancy rate. This protocol is ef®cient and acceptable in terms of cost even if a larger sample size is required.
A prospective, randomized comparison of two short stimulation protocol with agonist and antagonist of GnRH in poor responders patients undergoing IVF
MARCI, Roberto;
2003
Abstract
Introduction: Between 5±18% of patients presents a low response when stimulated for IVF cycles. The fertility of these patients could be compromized by the premature LH surge. The addition of GnRH antagonist to ovarian stimulation could prevent this eventuality, avoiding any suppression in the early follicular phase. In this multicentric, prospective study we compared two different stimulation protocols in poor responder patients undergoing IVF. Materials and methods: A total of 38 patients with a poor ovarian response in previous standard treatment (mean age 6 SD: 33.7 6 3.6 years; min = 24; max = 44),were selected on the basis of purely clinical criteria and divided into two groups: group I (n = 19) were stimulated with a ¯are-up short protocol using from day 2 of the cycle a daily dose of GnRH analogues (Triptorelina 0.1 mg/day s.c.; Decapeptyl) and 375 IU of r-FSH. Group II (n = 19) received 375 IU of r-FSH from day 2 of the cycle and daily dose of GnRH antagonist cetrorelix (Cetrotide, 0.25 mg) when two follicles had reached 14 mm of diameter until the day of HCG administration. Estradiol (E2) analysis and vaginal ultrasounds were performed to evaluate the ovarian response. In case of severe male factor, IVF was performed by ICSI. Results: On the 38 stimulated cycles we obtained the following results. (i) Mean stimulation duration (11.5 6 1.3 versus 12.0 6 1.2) and the number of ampoules (57.5 6 6.5 versus 60.0 6 6.3) used were not different between groups. (ii) Numbers, grade and quality of embryos transferred were comparable between two treatments. (iii) Fewer cycles were cancelled with the antagonist protocol (i versus iii). (iv) Three pregnancies were obtained with GnRH antagonist protocol (16.6% per embryo transfer) and two with GnRH ¯are-up agonist protocol (12.5% per embryo transfer). Conclusions: These data indicate that the use of GnRH antagonist multiple dose protocol allows the achievement of good results in terms of pregnancy rate. This protocol is ef®cient and acceptable in terms of cost even if a larger sample size is required.I documenti in SFERA sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
