A prospective randomized comparison of routine buserelin acetate and a decreasing dosage of nafarelin acetate with a low-dose gonadotropin-releasing hormone agonist protocol for in vitro fertilization and intracytoplasmic sperm injection.
OBJECTIVE
To compare the efficacy of a draw-back nafarelin acetate protocol with routine buserelin acetate administration for in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI).


METHODS
Prospective clinical study.


METHODS
Mie University School of Medicine, Tsu, Mie, Japan.


METHODS
One hundred sixty-nine women treated with IVF and 183 women treated with ICSI.


METHODS
Nafarelin acetate and buserelin acetate in ovarian hyperstimulation in IVF and ICSI were administered.


METHODS
The concentrations of estradiol (E(2)), FSH, LH, gonadotropin dosages; the number of oocytes retrieved, oocytes fertilized, and embryos; and pregnancy rates.


RESULTS
A prospective study was conducted with 44 cycles for 34 couples with nafarelin acetate (group 1) and 47 cycles for 40 couples with buserelin acetate (group 2) with a long IVF protocol; 68 cycles for 46 couples with nafarelin acetate (group 3) and 56 cycles for 39 couples with buserelin acetate (group 4) with a short IVF protocol; 39 cycles for 32 couples with nafarelin acetate (group 5) and 50 cycles for 30 couples with buserelin acetate (group 6) with a long ICSI protocol; and 87 cycles for 60 couples with nafarelin acetate (group 7) and 81 cycles for 61 couples with buserelin acetate (group 8) with a short ICSI protocol. Patients were randomized to receive either full-dose nafarelin acetate (200 microg b.i.d.) treatment for 7 days followed by half-dose nafarelin acetate (200 microg daily) or buserelin acetate (300 microg t.i.d.). There were no statistically significant differences in baseline concentrations of E(2) and FSH, concentrations of E(2), P4, FSH, LH on hCG administration, gonadotropin dosage, the number of oocytes retrieved and embryos transferred, or pregnancy rates between groups 1 and 2, groups 3 and 4, groups 5 and 6, and groups 7 and 8.


CONCLUSIONS
Full-dose nafarelin acetate treatment for 7 days followed by half-dose nafarelin acetate ("draw-back" protocol) is an effective new protocol for IVF and ICSI.
Takeuchi
S
S
Department of Obstetrics and Gynecology, Mie University School of Medicine, Tsu, Mie, Japan. shigeto@clin.medic.mie-u.ac.jp
Minoura
H
H
Shibahara
T
T
Tsuiki
Y
Y
Noritaka
F
F
Toyoda
N
N
D000022:Abortion, Spontaneous / Q000453:epidemiology; D000328:Adult; D002064:Buserelin / Q000627:therapeutic use*; D006063:Chorionic Gonadotropin / Q000627:therapeutic use; D010064:Embryo Implantation; D004624:Embryo Transfer; D004717:Endometrium / Q000166:cytology; D004958:Estradiol / Q000097:blood; D005260:Female; D005300:Fertility Agents, Female / Q000627:therapeutic use; D005307:Fertilization in Vitro; D005640:Follicle Stimulating Hormone / Q000097:blood; D006728:Hormones / Q000627:therapeutic use; D006801:Humans; D007986:Luteinizing Hormone / Q000097:blood; D008297:Male; D017274:Nafarelin / Q000627:therapeutic use*; D011247:Pregnancy; D011374:Progesterone / Q000097:blood; D011446:Prospective Studies; D020554:Sperm Injections, Intracytoplasmic; D013997:Time Factors
D006063:Chorionic Gonadotropin; D005300:Fertility Agents, Female; D006728:Hormones; D017274:Nafarelin; D011374:Progesterone; D004958:Estradiol; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone; D002064:Buserelin