title: Application of GnRH antagonist in combination with clomiphene citrate and hMG for patients with exaggerated ovarian response in previous IVF/ICSI cycles.
abstract: OBJECTIVE
  To investigate if the combination of clomiphene citrate, hMG, and cetrorelix (CC/hMG/cetrorelix protocol) can be applied to patients who had excessive response to GnRHa long protocol.
  
  
  METHODS
  Fifty patients who coasted and failed to conceive in their first cycles stimulated with GnRHa long protocol were stimulated with CC/hMG/cetrorelix protocol. The peak serum estradiol levels, the need of coasting and prolonged coasting (>/=4 days), and the incidences of OHSS were compared.
  
  
  RESULTS
  The peak estradiol level was significantly lower with CC/hMG/cetrorelix protocol compared to GnRHa long protocol. With CC/hMG/cetrorelix protocol, only four patients (8%) needed coasting and no one coasted >/=4 days. In contrast, in the first cycles, 11 patients (22%) needed coasting >/=4 days. The incidence of moderate OHSS was significantly lower with CC/hMG/cetrorelix protocol.
  
  
  CONCLUSIONS
  The CC/hMG/cetrorelix protocol is an acceptable alternative protocol for patients who had excessive response to GnRHa long protocol.
authors.affiliation: Department of Obstetrics and Gynecology, Shin Kong Wu Ho-Su Memorial Hospital, No. 95 Wen Chang Road, Shih Lin District, Taipei, 111, Taiwan.
authors.forename: Yu-Hung
authors.initials: YH
authors.lastname: Lin
authors.forename: Kok-Min
authors.initials: KM
authors.lastname: Seow
authors.forename: Bih-Chwen
authors.initials: BC
authors.lastname: Hsieh
authors.forename: Lee-Wen
authors.initials: LW
authors.lastname: Huang
authors.forename: Heng-Ju
authors.initials: HJ
authors.lastname: Chen
authors.forename: Shih-Chia
authors.initials: SC
authors.lastname: Huang
authors.forename: Chih-Yu
authors.initials: CY
authors.lastname: Chen
authors.forename: Pei-Hsin
authors.initials: PH
authors.lastname: Chen
authors.forename: Jiann-Loung
authors.initials: JL
authors.lastname: Hwang
authors.forename: Chi-Ruey
authors.initials: CR
authors.lastname: Tzeng
mesh_terms: D000328:Adult; D002996:Clomiphene / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D004624:Embryo Transfer; D004958:Estradiol / Q000097:blood; D005260:Female; D005300:Fertility Agents, Female / Q000008:administration & dosage*; D005307:Fertilization in Vitro; D005640:Follicle Stimulating Hormone / Q000097:blood; D007987:Gonadotropin-Releasing Hormone / Q000008:administration & dosage / Q000031:analogs & derivatives; D006727:Hormone Antagonists / Q000008:administration & dosage*; D006801:Humans; D008596:Menotropins / Q000008:administration & dosage; D016471:Ovarian Hyperstimulation Syndrome / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D010062:Ovulation Induction / Q000379:methods*; D011247:Pregnancy; D018873:Pregnancy Rate; D011446:Prospective Studies; D020554:Sperm Injections, Intracytoplasmic; D013480:Superovulation / Q000187:drug effects*; D016896:Treatment Outcome
chemical_list: D005300:Fertility Agents, Female; D006727:Hormone Antagonists; D002996:Clomiphene; D007987:Gonadotropin-Releasing Hormone; D004958:Estradiol; D008596:Menotropins; D005640:Follicle Stimulating Hormone; C062876:cetrorelix