Comparison of stimulation with clomiphene citrate in combination with recombinant follicle-stimulating hormone and recombinant luteinizing hormone to stimulation with a gonadotropin-releasing hormone agonist protocol: a prospective, randomized study.
OBJECTIVE
To compare IVF-ET outcome with a new stimulation protocol using clomiphene citrate (CC) with recombinant FSH and LH to stimulation with the standard long GnRH-a protocol.


METHODS
Prospective randomized study.


METHODS
Outpatient infertility clinic in Vienna, Austria.


METHODS
Two hundred ninety-four infertile women undergoing IVF-ET; 154 IVF cycles stimulated with CC + recombinant FSH + recombinant LH (group A) and 140 cycles with long GnRH-a suppression + recombinant FSH (group B).


METHODS
Controlled ovarian hyperstimulation, egg retrieval, and ET.


METHODS
Cycle parameters (number of oocytes, fertilization, number of embryos) and outcome (pregnancy rate, cancellation rate, ovarian hyperstimulation syndrome [OHSS]).


RESULTS
Pregnancy rate per ET was 42.9% (implantation rate, 21.3%) in group A and 36.6% (17.4%) in group B. Cancellation rates were similar. The OHSS occurred in four cases (3%) in group A and 12 cases (10%) in group B.


CONCLUSIONS
Stimulation with CC + recombinant FSH + recombinant LH leads to comparable pregnancy rates vs. the long protocol. With this new stimulation, less gonadotropins are used and there is less need for monitoring (lower cost for patient and clinic). The risk of OHSS is reduced as well. Therefore, this protocol should be regarded as the first-line treatment.
Weigert
Monika
M
Institut für Sterilitätsbetreuung, Vienna, Austria
Krischker
Ursula
U
Pöhl
Michaela
M
Poschalko
Gunda
G
Kindermann
Christoph
C
Feichtinger
Wilfried
W
D000328:Adult; D002996:Clomiphene / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D004624:Embryo Transfer; D005260:Female; D005300:Fertility Agents, Female; D005640:Follicle Stimulating Hormone / Q000627:therapeutic use*; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists*; D006728:Hormones / Q000627:therapeutic use*; D006801:Humans; D015994:Incidence; D007986:Luteinizing Hormone / Q000627:therapeutic use*; D008297:Male; D009865:Oocytes; D016471:Ovarian Hyperstimulation Syndrome / Q000453:epidemiology / Q000209:etiology; D010062:Ovulation Induction / Q000009:adverse effects / Q000379:methods*; D011247:Pregnancy; D011256:Pregnancy Outcome; D018873:Pregnancy Rate; D011446:Prospective Studies; D011994:Recombinant Proteins / Q000627:therapeutic use; D020858:Tissue and Organ Harvesting
D005300:Fertility Agents, Female; D006728:Hormones; D011994:Recombinant Proteins; D002996:Clomiphene; D007987:Gonadotropin-Releasing Hormone; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone