GnRH antagonist in older IVF patients. Retrieval rates and clinical outcome.
OBJECTIVE
To determine if the use of a midcycle GnRH antagonist provides better clinical outcomes and lower cancellation rates in in vitro fertilization (IVF).


METHODS
We examined all patients older than 40 years undergoing IVF-embryo transfer cycles between January 1999 and December 2000. Prior to June 2000, controlled ovarian stimulation in women > or = 40 years was performed with follicle stimulating hormone (FSH)/human menopausal gonadotropin (hMG) only and no GnRH agonist or antagonist (group I). After June 2000, following the release of Ganirelix in the U.S., all women > or = 40 years were stimulated with FSH/hMG + Ganirelix (group II). Outcomes of IVF cycles prior to Ganirelix were compared to results after its introduction.


RESULTS
Cancellation rates were significantly lower in group II (16%) as compared to group I (67%) (P < .05). In patients with oocytes retrieved, group II had a significantly higher number of recovered oocytes (7.7 +/- 0.8 vs. 5.3 +/- 0.7, P < .05). However, the number of embryos transferred, cumulative embryo scores, implantation rates and ongoing pregnancy rates did not differ significantly between groups.


CONCLUSIONS
Although our results are preliminary, the addition of GnRH antagonist avoids ovarian suppression at the start of controlled ovarian hyperstimulation and prevents the premature LH surge at midcycle. Thus, more patients attempting IVF undergo oocyte retrieval, although clinical outcomes may not necessarily be improved.
Chang
Peter L
PL
Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York, USA. pchang@chpnet.org
Zeitoun
Khaled M
KM
Chan
Lai-King
LK
Thornton
Melvin H
MH
Sauer
Mark V
MV
D000328:Adult; D000367:Age Factors; D004359:Drug Therapy, Combination; D005260:Female; D005300:Fertility Agents, Female / Q000008:administration & dosage / Q000494:pharmacology*; D005307:Fertilization in Vitro / Q000187:drug effects*; D005640:Follicle Stimulating Hormone / Q000008:administration & dosage / Q000494:pharmacology*; D007987:Gonadotropin-Releasing Hormone / Q000031:analogs & derivatives* / Q000494:pharmacology*; D006727:Hormone Antagonists / Q000494:pharmacology*; D006728:Hormones / Q000008:administration & dosage / Q000494:pharmacology*; D006801:Humans; D008596:Menotropins / Q000008:administration & dosage / Q000494:pharmacology*; D008597:Menstrual Cycle / Q000187:drug effects; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies
D005300:Fertility Agents, Female; D006727:Hormone Antagonists; D006728:Hormones; D007987:Gonadotropin-Releasing Hormone; D008596:Menotropins; D005640:Follicle Stimulating Hormone; C061018:ganirelix