title: Minimal ovarian hyperstimulation for in vitro fertilization using sequential clomiphene citrate and gonadotropin with or without the addition of a gonadotropin-releasing hormone antagonist.
abstract: OBJECTIVE
  To compare the results of a minimal-stimulation protocol with those of a standard protocol used for IVF.
  
  
  METHODS
  Retrospective, controlled study.
  
  
  METHODS
  University center.
  
  
  METHODS
  Fifty-five patients undergoing IVF using a minimal-stimulation protocol with or without adjuvant therapy with a GnRH antagonist. A control group consisted of age- and diagnosis-matched patients undergoing a standard long GnRH agonist (GnRH-a)-gonadotropin stimulation during the same time period.
  
  
  METHODS
  Clomiphene citrate and gonadotropins, with or without the GnRH antagonist ganirelix.
  
  
  METHODS
  Oocytes recovered and pregnancy rates.
  
  
  RESULTS
  The number of oocytes retrieved was significantly lower for the minimal-stimulation regimen compared with the case of the long GnRH-a protocol (4.8 +/- 2.6 vs. 16.2 +/- 7.5, respectively). The clinical pregnancy rate per transfer, however, was not significantly different between the two regimens (37% vs. 41%, minimal stimulation vs. long GnRH-a protocol, respectively). The addition of ganirelix resulted in at least the same pregnancy outcome as compared with the case of cycles without the antagonist.
  
  
  CONCLUSIONS
  Minimal stimulation using clomiphene citrate followed by gonadotropin for IVF results in pregnancy rates equal to the standard long GnRH-a-gonadotropin protocol. The addition of ganirelix resulted in at least similar results with the advantage of eliminating the occurrence of a premature endogenous LH surge.
authors.affiliation: Jones Institute for Reproductive Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia 23507, USA. williasc@evms.edu
authors.forename: Shaun C
authors.initials: SC
authors.lastname: Williams
authors.forename: William E
authors.initials: WE
authors.lastname: Gibbons
authors.forename: Suheil J
authors.initials: SJ
authors.lastname: Muasher
authors.forename: Sergio
authors.initials: S
authors.lastname: Oehninger
mesh_terms: D000328:Adult; D002996:Clomiphene / Q000627:therapeutic use*; D005260:Female; D005307:Fertilization in Vitro; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists / Q000031:analogs & derivatives* / Q000037:antagonists & inhibitors* / Q000627:therapeutic use; D006062:Gonadotropins / Q000627:therapeutic use*; D006727:Hormone Antagonists / Q000627:therapeutic use; D006801:Humans; D009865:Oocytes; D010062:Ovulation Induction; D011247:Pregnancy; D018873:Pregnancy Rate; D012189:Retrospective Studies; D020858:Tissue and Organ Harvesting
chemical_list: D006062:Gonadotropins; D006727:Hormone Antagonists; D002996:Clomiphene; D007987:Gonadotropin-Releasing Hormone; C061018:ganirelix