Multifollicular recruitment in combination with gonadotropin-releasing hormone antagonist increased pregnancy rates in intrauterine insemination cycles.
OBJECTIVE
To determine whether including a GnRH antagonist in controlled ovarian stimulation-intrauterine insemination cycles would increase pregnancy rates.


METHODS
Prospective randomized study.


METHODS
Private reproductive medicine clinic in Spain.


METHODS
Three hundred sixty-seven women with primary or secondary infertility.


METHODS
Patients were randomly assigned to controlled ovarian stimulation with recombinant FSH (75-150 IU/d) alone (controls, n = 183) or with recombinant FSH (75-150 IU/d) + the GnRH antagonist (0.25 mg/d), initiated when the recruited follicles were >or=16 mm (n = 184). A single insemination was performed, 36-38 hours after hCG (5,000 IU, IM), in both groups.


METHODS
Follicular recruitment, pregnancy rates.


RESULTS
Numbers of mature follicles (2.4 +/- 1.3 vs. 1.3 +/- 1.09) and clinical pregnancy rates (23% vs. 11%) were statistically significantly higher in patients who were treated with GnRH antagonist than in those who were in the control group. The pregnancy rate was only higher in the antagonist group if more than one follicle sized >or=18 mm was present on the day that the hCG was given. A similar number of twin pregnancies occurred in both groups: two in the antagonist group and three in the control group. The antagonist group also had one triplet gestation.


CONCLUSIONS
Adding GnRH antagonist to controlled ovarian stimulation-intrauterine insemination cycles significantly increases pregnancy rates in multifollicular, but not monofollicular, cycles.
Clínica de Medicina de la Reproducción y Ginecología FivMadrid, Madrid, Spain.
Jose Luis
JL
Gómez-Palomares
Belén
B
Acevedo-Martín
Marián
M
Chávez
M  Angeles
M
Manzanares
Elisabetta
E
Ricciarelli
Eleuterio R
ER
Hernández
D000328:Adult; D006063:Chorionic Gonadotropin / Q000008:administration & dosage; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D005300:Fertility Agents, Female / Q000008:administration & dosage / Q000627:therapeutic use*; D005640:Follicle Stimulating Hormone / Q000627:therapeutic use; D007987:Gonadotropin-Releasing Hormone / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000037:antagonists & inhibitors* / Q000378:metabolism / Q000627:therapeutic use; D006727:Hormone Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007247:Infertility, Female / Q000378:metabolism / Q000628:therapy*; D007315:Insemination, Artificial; D006080:Ovarian Follicle / Q000187:drug effects*; D010062:Ovulation Induction; D011247:Pregnancy; D018873:Pregnancy Rate; D011446:Prospective Studies; D011994:Recombinant Proteins / Q000627:therapeutic use; D016896:Treatment Outcome
D006063:Chorionic Gonadotropin; D005300:Fertility Agents, Female; D006727:Hormone Antagonists; D011994:Recombinant Proteins; D007987:Gonadotropin-Releasing Hormone; D005640:Follicle Stimulating Hormone; C062876:cetrorelix