Comparison of short 7-day and prolonged treatment with gonadotropin-releasing hormone agonist desensitization for controlled ovarian hyperstimulation.
OBJECTIVE
To compare two treatment regimens associating a gonadotropin-releasing hormone agonist (GnRH-a) and human menopausal gonadotropin (hMG) for controlled ovarian hyperstimulation (COH).


METHODS
A prospective randomized trial.


METHODS
The outpatient fertility clinic of a university tertiary care center, the Hôpital A. Béclère, Clamart, France.


METHODS
One hundred eighty-two in vitro fertilization (IVF) candidates undergoing new or repeat IVF cycles at Hôpital A. Béclère over a 4-month period.


METHODS
Group 1 (7-day protocol): A short-acting preparation of GnRH-a (Tripteriline 0.1) was administered daily for 7 days, starting on cycle day 2. Ovarian stimulation with hMG was started on cycle day 4. Group 2 (long protocol): A timed release preparation of GnRH-a (Tripteriline 3.75 mg) was administered on cycle day 2. Ovarian stimulation with hMG was started after documented ovarian suppression.


METHODS
Response to COH, pregnancy rate (PR), tolerance.


RESULTS
In the 7-day protocol, the amount of hMG required was markedly lower at 24 +/- 7 than in the long protocol group requiring 42.5 +/- 9.75 vials (75 IU) (mean +/- SD). No elevation of plasma LH occurred in either group. The number of oocytes retrieved was 7.3 +/- 1 and 10.7 +/- 1.2 (mean +/- SD) in the 7-day and long protocols, respectively. Yet, the number of embryos obtained and the PRs were similar in the two treatment groups.


CONCLUSIONS
We observed that in COH, GnRH-a treatment could be interrupted safely several days before human chorionic gonadotropin administration without risking a premature increase of plasma luteinizing hormone. Moreover, the number of embryos available for fresh transfer and the ongoing PRs were similar in the new 7-day and in the classic long GnRH-a/hMG protocols, despite the smaller number of oocytes suggesting a greater efficiency of the 7-day protocol. The peak estradiol level and the hMG requirement were also lower in the 7-day GnRH-a/hMG protocol.
Hazout
A
A
Department of Obstetrics and Gynecology, Hôpital A. Béclère, Clamart, France.
de Ziegler
D
D
Cornel
C
C
Fernandez
H
H
Lelaidier
C
C
Frydman
R
R
D000328:Adult; D003692:Delayed-Action Preparations; D004624:Embryo Transfer; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D007247:Infertility, Female / Q000188:drug therapy; D007986:Luteinizing Hormone / Q000097:blood; D008596:Menotropins / Q000008:administration & dosage / Q000627:therapeutic use; D010053:Ovary / Q000187:drug effects*; D011446:Prospective Studies; D013997:Time Factors; D017329:Triptorelin Pamoate / Q000008:administration & dosage* / Q000627:therapeutic use
D003692:Delayed-Action Preparations; D017329:Triptorelin Pamoate; D008596:Menotropins; D007986:Luteinizing Hormone