Ovarian stimulation by concomitant administration of cetrorelix acetate and HMG following Diane-35 pre-treatment for patients with polycystic ovary syndrome: a prospective randomized study.
BACKGROUND
Patients with polycystic ovary syndrome (PCOS) may need a longer period of pituitary downregulation to suppress the elevated serum LH and androgen levels effectively during IVF treatment using the GnRH agonist long protocol. We proposed a stimulation protocol incorporating Diane-35 and GnRH antagonist (Diane/cetrorelix protocol) and compared it with the GnRH agonist long protocol for PCOS patients.


METHODS
Part I of the study was an observational pilot study to evaluate the hormonal change as a result of the Diane/cetrorelix protocol (n = 26). Part II of the study was a prospective randomized study comparing the Diane/cetrorelix protocol (n = 25) and the GnRH agonist long protocol (n = 24). In the Diane/cetrorelix protocol, patients were pre-treated with three cycles of Diane-35, followed by 0.25 mg of cetrorelix on cycle day 3. From day 4, cetrorelix and gonadotrophin were administered concomitantly until the day of HCG injection.


RESULTS
Serum LH, estradiol and testosterone levels were suppressed comparably in both protocols at the start of gonadotrophin administration. Serum LH was suppressed at constant levels without a premature LH surge in the Diane/cetrorelix protocol. The clinical results for both protocols were comparable, with significantly fewer days of injection, lower amounts of gonadotrophin used and lower estradiol levels on the day of HCG injection following the Diane/cetrorelix protocol. Furthermore, there was no significant difference in clinical pregnancy outcome between the two stimulation protocols.


CONCLUSIONS
The Diane/cetrorelix protocol has a similar pregnancy outcome to the GnRH agonist long protocol for women with PCOS undergoing IVF treatment.
Department of Obstetrics and Gynecology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan. m001015@ms.skh.org.tw
Jiann-Loung
JL
Hwang
Kok-Min
KM
Seow
Yu-Hung
YH
Lin
Lee-Wen
LW
Huang
Bih-Chwen
BC
Hsieh
Yieh-Loong
YL
Tsai
Gong-Jhe
GJ
Wu
Shih-Chia
SC
Huang
Chin-Yu
CY
Chen
Pei-Hsin
PH
Chen
Chii-Ruey
CR
Tzeng
D000328:Adult; D000726:Androgen Antagonists / Q000627:therapeutic use*; D017373:Cyproterone Acetate / Q000627:therapeutic use*; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D004997:Ethinyl Estradiol / Q000627:therapeutic use*; D005260:Female; D005307:Fertilization in Vitro; D007987:Gonadotropin-Releasing Hormone / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D006727:Hormone Antagonists / Q000627:therapeutic use*; D006728:Hormones / Q000097:blood; D006801:Humans; D015994:Incidence; D007247:Infertility, Female / Q000097:blood / Q000188:drug therapy* / Q000209:etiology / Q000628:therapy; D008596:Menotropins / Q000627:therapeutic use*; D016471:Ovarian Hyperstimulation Syndrome / Q000453:epidemiology / Q000209:etiology; D010062:Ovulation Induction / Q000009:adverse effects; D010865:Pilot Projects; D011085:Polycystic Ovary Syndrome / Q000150:complications*; D011247:Pregnancy; D011256:Pregnancy Outcome; D018873:Pregnancy Rate; D011292:Premedication
D000726:Androgen Antagonists; D004338:Drug Combinations; D006727:Hormone Antagonists; D006728:Hormones; D007987:Gonadotropin-Releasing Hormone; D004997:Ethinyl Estradiol; D017373:Cyproterone Acetate; C032640:Cyproterone acetate, ethinyl estradiol drug combination; D008596:Menotropins; C062876:cetrorelix