title: Long-term down-regulation does not improve pregnancy rates in an in vitro fertilization program.
abstract: OBJECTIVE
  To investigate the effects of long-term down-regulation (4 months) used in combination with gonadotropin ovarian stimulation for IVF-ET.
  
  
  METHODS
  Prospective randomized study.
  
  
  METHODS
  Assisted Reproduction Unit of the Hospital Clinic i Provincial in Barcelona, a tertiary care setting.
  
  
  METHODS
  Thirty pairs of IVF patients who were matched for age, indication for IVF, and number of attempts.
  
  
  METHODS
  Women were randomized to receive a standard long protocol of SC leuprolide acetate (n = 30, group L) or a monthly injection of leuprolide acetate depot for 4 months (n = 30, group D) before gonadotropin stimulation.
  
  
  METHODS
  Ovarian response and IVF outcome.
  
  
  RESULTS
  Days of ovarian stimulation, follicular recruitment and growth during gonadotropin treatment, and the endometrial thickness on the day of hCG administration were similar for the 2 groups of IVF patients. However, the serum concentration of E2 was significantly higher in group L even though group D received a higher total dose of gonadotropins. The number of follicles punctured, the number of oocytes retrieved, the number of oocytes fertilized, the number of embryos suitable for replacement and cryopreservation, the number of patients with ET, and implantation and clinical pregnancy rates were similar for groups L and D. However, the percentage of metaphase II oocytes was significantly higher in group L than in group D.
  
  
  CONCLUSIONS
  Long-term down-regulation does not improve pregnancy rates in a general IVF program.
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine-University of Barcelona, Hospital Clinic i Provincial, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Fábregues
authors.forename: J
authors.initials: J
authors.lastname: Balasch
authors.forename: M
authors.initials: M
authors.lastname: Creus
authors.forename: S
authors.initials: S
authors.lastname: Cívico
authors.forename: F
authors.initials: F
authors.lastname: Carmona
authors.forename: B
authors.initials: B
authors.lastname: Puerto
authors.forename: J A
authors.initials: JA
authors.lastname: Vanrell
mesh_terms: D000328:Adult; D018931:Antineoplastic Agents, Hormonal / Q000494:pharmacology; D003692:Delayed-Action Preparations; D015536:Down-Regulation / Q000502:physiology*; D005260:Female; D005307:Fertilization in Vitro / Q000706:statistics & numerical data; D012739:Gonadal Steroid Hormones / Q000097:blood; D006062:Gonadotropins / Q000627:therapeutic use; D006801:Humans; D007247:Infertility, Female / Q000503:physiopathology / Q000628:therapy*; D016729:Leuprolide / Q000494:pharmacology; D010063:Ovum / Q000187:drug effects; D011247:Pregnancy; D011446:Prospective Studies; D013268:Stimulation, Chemical; D016896:Treatment Outcome
chemical_list: D018931:Antineoplastic Agents, Hormonal; D003692:Delayed-Action Preparations; D012739:Gonadal Steroid Hormones; D006062:Gonadotropins; D016729:Leuprolide