Should gonadotropin-releasing hormone down-regulation therapy be routine in in vitro fertilization?
OBJECTIVE
To compare the classic clomiphene citrate (CC) and hMG regime for ovarian stimulation before IVF in women who received hMG post-long protocol down-regulation with either 3 mg triptorelin [INN] IM or 150 mg buserelin acetate four times daily intranasally. Furthermore, if possible, to determine the preferred method of down-regulation.


METHODS
A prospective study of 150 women randomized blind to the clinician to one of three alternative ovarian stimulation regimes when passing for the first time through an IVF program during 1992.


RESULTS
Triptorelin [INN] down-regulated significantly more quickly than buserelin acetate. The non-down-regulated group CC and hMG used significantly less hMG in a shorter time. In these women LH levels at hCG administration were significantly higher. No other intergroup differences were found. Pregnancy and take-home baby rates for the overall study were, respectively, 32%:25% (per cycle) and 42%:33%; (per ET) for the triptorelin [INN] group 28%:22% and 39%:31%; the CC group 32%:24% and 46%:34%; and the buserelin acetate group 34%:28% and 42%:34%.


CONCLUSIONS
Triptorelin [INN] and buserelin acetate were comparable in all parameters except down-regulation. The former was significantly quicker and more sure. In none of the clinical end points measured, however, was the classic CC and hMG non-down-regulation regime significantly less effective or troublesome than where down-regulation was used. These results therefore show that although indications for down-regulation before IVF exist, it should not be used on all patients.
Harrison
R F
RF
Royal College of Surgons, Department of Obstetrics and Gynaecology, Rotunda Hospital, Dublin, Ireland.
Kondaveeti
U
U
Barry-Kinsella
C
C
Gordon
A
A
Drudy
L
L
Cottell
E
E
Hennelly
B
B
Frankish
A
A
Unwin
A
A
D000328:Adult; D002064:Buserelin / Q000627:therapeutic use*; D002996:Clomiphene / Q000627:therapeutic use; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods*; D006801:Humans; D007247:Infertility, Female / Q000209:etiology; D008297:Male; D008596:Menotropins / Q000627:therapeutic use; D010062:Ovulation Induction; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies; D017329:Triptorelin Pamoate / Q000627:therapeutic use*
D017329:Triptorelin Pamoate; D002996:Clomiphene; D008596:Menotropins; D002064:Buserelin