A prospective randomized study comparing gonadotropin-releasing hormone agonists or gonadotropin-releasing hormone antagonists in couples with unexplained infertility and/or mild oligozoospermia.
OBJECTIVE
To compare the efficacy of GnRH antagonist vs. GnRH agonist administration for controlled ovarian hyperstimulation (COH) in assisted reproduction.


METHODS
A prospective, randomized trial.


METHODS
Clinical research unit at a tertiary care medical center.


METHODS
Sixty-five patients with unexplained infertility or mild male subfertility undergoing COH for IUI.


METHODS
Twenty-nine women (group A) were randomized to receive 600 microg of busereline acetate per day starting in the midluteal phase of the cycle (long protocol), whereas 36 women (group B) were treated with 0.25 mg/d of the GnRH antagonist Cetrorelix starting from day 6 of the cycle. The starting dose of recombinant FSH was 150 IU in women of both groups. Insemination was performed 34 hours after hCG injection.


METHODS
Clinical and successful ongoing pregnancy rate (PR), measurements of serum FSH, LH, E2, and P, number of recruited follicles, duration of stimulation period, and amount of gonadotropins used.


RESULTS
Women in group A required significantly more days of treatment (median: 12.0 vs. 9.0) and significantly more total units of recombinant FSH (median 1,800 vs. 1,550) as compared with the corresponding values of the antagonist group (group B). Serum FSH, LH, E2, and P were significantly higher on the antagonist group on days 2 and 6 of stimulation. However, these differences regress until the day of hCG administration.


CONCLUSIONS
The GnRH antagonists have facilitated short and simple treatment, and are particularly attractive for administration in women undergoing COH, achieving comparable PR with the long protocol regimen.
Zikopoulos
Konstantinos
K
Centre for Reproductive Medicine, Department of Obstetrics and Gynecology, Ioannina University School of Medicine, Ioannina, Greece. kostaszikopoulos@hotmail.com
Kaponis
Apostolos
A
Adonakis
Georgios
G
Sotiriadis
Alexandros
A
Kalantaridou
Sofia
S
Georgiou
Ioannis
I
Paraskevaidis
Evangelos
E
D000328:Adult; D016009:Chi-Square Distribution; D016001:Confidence Intervals; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists* / Q000031:analogs & derivatives / Q000037:antagonists & inhibitors* / Q000097:blood / Q000627:therapeutic use; D006727:Hormone Antagonists / Q000627:therapeutic use; D006801:Humans; D007247:Infertility, Female / Q000097:blood / Q000188:drug therapy*; D008297:Male; D009845:Oligospermia / Q000097:blood / Q000188:drug therapy*; D011247:Pregnancy; D011446:Prospective Studies; D018709:Statistics, Nonparametric
D006727:Hormone Antagonists; D007987:Gonadotropin-Releasing Hormone; C062876:cetrorelix