title: High doses of gonadotrophins combined with stop versus non-stop protocol of GnRH analogue administration in low responder IVF patients: a prospective, randomized, controlled trial.
abstract: Recent evidence suggests that early cessation of gonadotrophin releasing hormone analogue (GnRHa) administration may offer some benefit to low responder patients undergoing IVF. A prospective, randomized controlled trial was designed to evaluate whether early cessation of GnRHa in an ovarian stimulation regimen is more beneficial than just increasing the doses of gonadotrophins. Seventy low responder patients (less than three mature follicles in a previous cycle) with normal basal follicle stimulating hormone concentrations and a previous cancelled IVF cycle were randomly allocated into two protocols: (i) non-stop protocol: long GnRHa suppression with high doses of gonadotrophins, and (ii) stop protocol, in which GnRHa administration is stopped with the onset of menses, while gonadotrophin doses remained similar to the non-stop protocol. A significantly higher number of mature oocytes were obtained in the study group (stop protocol) compared to the control group (non-stop protocol) (8.7 +/- 0.9 versus 6.2 +/- 0.7, P: = 0. 027). The stop protocol reduced the number of ampoules of gonadotrophins required (56.6 +/- 2.7 versus 68.0 +/- 3.5, P: = 0. 013). Both protocols resulted in a similar cancellation rate (2.7 versus 5.8%) (with no cycles cancelled due to ovulation), pregnancy rate (14.3 versus 18.7%), and implantation rate (12.1 versus 8.8%). The early cessation of GnRHa combined with high doses of gonadotrophins permitted the retrieval of a significantly higher number of oocytes.
authors.affiliation: IVI-Madrid, Madrid, Instituto Valenciano de Infertilidad (IVI) and Department of Paediatrics, Obstetrics and Gynaecology, Valencia University School of Medicine, Valencia, Spain. ivimadrid@ivi.es
authors.forename: J A
authors.initials: JA
authors.lastname: Garcia-Velasco
authors.forename: V
authors.initials: V
authors.lastname: Isaza
authors.forename: A
authors.initials: A
authors.lastname: Requena
authors.forename: F J
authors.initials: FJ
authors.lastname: Martínez-Salazar
authors.forename: A
authors.initials: A
authors.lastname: Landazábal
authors.forename: J
authors.initials: J
authors.lastname: Remohí
authors.forename: A
authors.initials: A
authors.lastname: Pellicer
authors.forename: C
authors.initials: C
authors.lastname: Simón
mesh_terms: D000328:Adult; D002452:Cell Count; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D010064:Embryo Implantation; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods*; D005640:Follicle Stimulating Hormone / Q000008:administration & dosage* / Q000627:therapeutic use; D007987:Gonadotropin-Releasing Hormone / Q000031:analogs & derivatives*; D006801:Humans; D008596:Menotropins / Q000008:administration & dosage* / Q000627:therapeutic use; D009865:Oocytes / Q000166:cytology; D011247:Pregnancy; D018873:Pregnancy Rate; D011446:Prospective Studies; D019233:Retreatment; D013048:Specimen Handling / Q000379:methods
chemical_list: D007987:Gonadotropin-Releasing Hormone; D008596:Menotropins; D005640:Follicle Stimulating Hormone