Application of GnRH antagonist in combination with clomiphene citrate and hMG for patients with exaggerated ovarian response in previous IVF/ICSI cycles.
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.
Lin
Yu-Hung
YH
Department of Obstetrics and Gynecology, Shin Kong Wu Ho-Su Memorial Hospital, No. 95 Wen Chang Road, Shih Lin District, Taipei, 111, Taiwan.
Seow
Kok-Min
KM
Hsieh
Bih-Chwen
BC
Huang
Lee-Wen
LW
Chen
Heng-Ju
HJ
Huang
Shih-Chia
SC
Chen
Chih-Yu
CY
Chen
Pei-Hsin
PH
Hwang
Jiann-Loung
JL
Tzeng
Chi-Ruey
CR
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
D005300:Fertility Agents, Female; D006727:Hormone Antagonists; D002996:Clomiphene; D007987:Gonadotropin-Releasing Hormone; D004958:Estradiol; D008596:Menotropins; D005640:Follicle Stimulating Hormone; C062876:cetrorelix