Use of a GnRH antagonist in controlled ovarian hyperstimulation for assisted conception in women with polycystic ovary disease: a randomized, prospective, pilot study.
OBJECTIVE
To compare the outcome of using gonadotropin-releasing hormone (GnRH) antagonists versus agonists in women with polycystic ovary disease (PCOD) who underwent controlled ovarian hyperstimulation (COH) for assisted reproductive techniques (ART).


METHODS
A total of 129 patients with PCOD were randomly allocated to undergo COH with a GnRH antagonist (59 patients) and GnRH agonist (leuprolide acetate) (70 patients) to prevent a premature luteinizing hormone (LH) surge. Assisted fertilization following oocyte retrieval and embryo transfer was performed.


RESULTS
None of the cycles were cancelled due to a premature LH surge. There was no significant difference between the antagonist and agonist arms in the number of gonadotropin ampules consumed per cycle. However, in the antagonist arm a shorter duration of ovarian stimulation was recorded as compared to the agonist arm. Although similar numbers of oocytes was retrieved from both groups of patients, the quality of the oocytes, as measured by metaphase 2/total oocyte ratio, was lower in the antagonist arm as compared to the agonist arm. Pregnancy rates were 57.6% and 58.5% in the antagonist and agonist arms, respectively (p > 0.05). Implantation rates were not different (34.0% and 34.6%, respectively). The frequency of ovarian hyperstimulation syndrome also did not differ between the treatment groups (5% and 7.1%, respectively).


CONCLUSIONS
The size of our study, on a specific subgroup of patients, does not allow a reliable conclusion regarding ART outcomefollowing the use of a GnRH antagonist versus agonist. Nevertheless, the protocol with the antagonist gave results that were as good as those of the protocol with the agonist in this PCOD patient population.
Bahçeci
Mustafa
M
Bahceci Women's Health Care Center, Istanbul, Turkey. mbahceci@superonline.com
Ulug
Ulun
U
Ben-Shlomo
Izhar
I
Erden
Halit Firat
HF
Akman
Mehmet Ali
MA
D000328:Adult; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods*; D005500:Follow-Up Studies; D007987:Gonadotropin-Releasing Hormone / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D006727:Hormone Antagonists / Q000627:therapeutic use*; D006801:Humans; D007247:Infertility, Female / Q000188:drug therapy* / Q000209:etiology; D016729:Leuprolide / Q000627:therapeutic use*; D010062:Ovulation Induction / Q000379:methods; D010865:Pilot Projects; D011085:Polycystic Ovary Syndrome / Q000150:complications* / Q000175:diagnosis; D011247:Pregnancy; D018873:Pregnancy Rate; D011336:Probability; D011446:Prospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric
D006727:Hormone Antagonists; D007987:Gonadotropin-Releasing Hormone; D016729:Leuprolide; C062876:cetrorelix