Long-term down-regulation does not improve pregnancy rates in an in vitro fertilization program.
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.
Fábregues
F
F
Department of Obstetrics and Gynecology, Faculty of Medicine-University of Barcelona, Hospital Clinic i Provincial, Spain.
Balasch
J
J
Creus
M
M
Cívico
S
S
Carmona
F
F
Puerto
B
B
Vanrell
J A
JA
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
D018931:Antineoplastic Agents, Hormonal; D003692:Delayed-Action Preparations; D012739:Gonadal Steroid Hormones; D006062:Gonadotropins; D016729:Leuprolide