A randomized prospective study of early follicular or midluteal initiation of long protocol gonadotropin-releasing hormone in an in vitro fertilization program.
OBJECTIVE
To determine the optimum menstrual cycle time to initiate a long-protocol gonadotropin-releasing hormone agonist (GnRH-a) down-regulation regimen before hMG stimulation before IVF.


METHODS
Randomized, prospective, single, first cycle study.


METHODS
University teaching hospital.


METHODS
Eighty-six infertile couples undergoing IVF-ET attempt under rules for Ireland.


METHODS
Gonadotropin-releasing hormone agonist administered intranasally from day 1 or 21 of menstrual cycle. Human menopausal gonadotropin commenced when pituitary down-regulation was confirmed.


METHODS
Ovarian response, cancellation, fertilization, and pregnancy rates.


RESULTS
No significant differences found between day 1 and day 21 initiation. But starting on day 1 is more easily recognizable by patients and avoids the possibility of administering GnRH-a in the presence of an unsuspected pregnancy.


CONCLUSIONS
Both follicular and luteal phase initiation of GnRH-a long-protocol down-regulation are equally efficacious. In our clinical context, patients and management favor commencing on day 1.
Kondaveeti-Gordon
U
U
Human Assisted Reproduction, Ireland.
Harrison
R F
RF
Barry-Kinsella
C
C
Gordon
A C
AC
Drudy
L
L
Cottell
E
E
D000328:Adult; D002064:Buserelin / Q000494:pharmacology*; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D008596:Menotropins / Q000494:pharmacology; D008597:Menstrual Cycle / Q000187:drug effects*; D011247:Pregnancy; D011446:Prospective Studies
D008596:Menotropins; D002064:Buserelin