A preliminary study on reduced dose (33 or 25 microg) gonadotropin-releasing hormone agonist long protocol for multifollicular ovarian stimulation in patients with high basal serum follicle-stimulating hormone levels undergoing in vitro fertilization-embryo transfer

Seung-Yup Ku, Seung‐Yup Ku, Young Sik Choi, Byung Chul Jee, Chang Suk Suh, Young Min Choi, Jung Gu Kim, Shin Yong Moon, Seok Hyun Kim
Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology · 2005 · vol. 21(4) , pp. 227–231 · doi:10.1080/09513590500282125 · PMID:16316845 · W1982404441
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Reduced dose GnRH-a long protocols improved estradiol levels and embryo quality in IVF patients with high FSH, without significantly impacting pregnancy rates.

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Abstract

The aim of the present study was to evaluate the clinical efficacy of half-dose (50 mug) and further reduced dose (33 or 25 mug) gonadotropin-releasing hormone agonist (GnRH-a; triptorelin) long protocols for multifollicular ovarian stimulation (MFOS) for patients with high basal serum follicle-stimulating hormone (FSH) level undergoing in vitro fertilization and embryo transfer (IVF-ET). One hundred and two IVF-ET cycles performed in 84 infertile patients with high basal serum FSH (>10.0 mIU/ml) were included in this retrospective study. Study subjects were assigned to two groups: continuous half-dose GnRH-a long protocol (group A, n = 63) vs. further reduced dose GnRH-a long protocol (group B, n = 39) from half-dose at the start of GnRH-a to one-third or one-quarter dose after pituitary downregulation. Exogenous FSH or human menopausal gonadotropin was administered for MFOS in step-down mode, four or fewer embryos were transferred, and the outcomes of MFOS were compared between the two groups. Serum estradiol (E(2)) level on the day of human chorionic gonadotropin administration was significantly higher in group B (mean +/- standard deviation (SD): 1318.3 +/- 1120.4 vs. 2054.9 +/- 1773.5 pg/ml, p = 0.015). The number of transferable and good-quality embryos was also significantly higher in group B (mean +/- SD: 2.9 +/- 1.7 vs. 3.7 +/- 2.0, p = 0.027; 1.8 +/- 1.4 vs. 2.7 +/- 2.0, p = 0.020). No statistically significant difference in the outcomes was observed with respect to the dose of gonadotropins administered, the number of oocytes retrieved or the clinical pregnancy rate. In conclusion, GnRH-a long protocol with a reduced dose, tapered from the starting half-dose to a third or a quarter of the normal dose after pituitary suppression, may be beneficial for MFOS in IVF-ET patients with a high basal serum FSH level. A further prospective randomized controlled study on a larger scale is needed to confirm these findings.

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MeSH descriptors

Embryo Transfer Fertilization in Vitro Follicle Stimulating Hormone Ovulation Induction Triptorelin Pamoate Adult Chorionic Gonadotropin Chorionic Gonadotropin Dose-Response Relationship, Drug Estradiol Estradiol Female Follicle Stimulating Hormone Follicle Stimulating Hormone Humans Infertility, Female Infertility, Female Menotropins Menotropins Ovarian Follicle

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