The routine use of gonadotropin-releasing hormone agonists for all patients undergoing in vitro fertilization. Is there any medical advantage? A prospective randomized study.
OBJECTIVE
To determine if the routine use of gonadotropin-releasing hormone agonists (GnRH-a) for all patients undergoing in vitro fertilization (IVF) produces any significant medical advantage.


METHODS
Prospective randomized study.


METHODS
Three hundred eight patients having their first ever IVF attempt.


METHODS
Patients were randomly divided into four groups and received either human menopausal gonadotropin (hMG) alone for ovarian simulation (group A, n = 81); clomiphene citrate and hMG (group B, n = 77); a 3-day ultrashort course of GnRH-a and hMG (group C, n = 74); or pituitary desensitization with GnRH-a followed by hMG (group D, n = 76).


RESULTS
The indications for IVF and mean age of all four groups of patients were comparable. There was a significant difference in the number of embryos cleaved and transferred among the groups, but there were no significant differences in the cancellation rate, mean number of oocytes collected or fertilized, and number of cases of failed fertilization. There were also no significant differences in the pregnancy and live birth rates per cycle commenced or per embryo transfer.


CONCLUSIONS
The routine use of GnRH-a for all patients undergoing IVF has practical but no significant medical advantages.
Kingsland
C
C
Hallam Medical Centre, King's College School of Medicine and Dentistry, London, United Kingdom.
Tan
S L
SL
Bickerton
N
N
Mason
B
B
Campbell
S
S
D000022:Abortion, Spontaneous; D002996:Clomiphene / Q000627:therapeutic use*; D003692:Delayed-Action Preparations; D004334:Drug Administration Schedule; D005260:Female; D005307:Fertilization in Vitro; D007987:Gonadotropin-Releasing Hormone / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D007247:Infertility, Female / Q000209:etiology; D008596:Menotropins / Q000627:therapeutic use*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011271:Pregnancy, Ectopic; D011446:Prospective Studies; D017329:Triptorelin Pamoate / Q000031:analogs & derivatives*
D003692:Delayed-Action Preparations; D017329:Triptorelin Pamoate; D002996:Clomiphene; D007987:Gonadotropin-Releasing Hormone; C019176:Tryptal; D008596:Menotropins