J Korean Med Sci.  2009 Apr;24(2):262-268. 10.3346/jkms.2009.24.2.262.

Cessation of Gonadotropin-Releasing Hormone Antagonist on Triggering Day: An Alternative Method for Flexible Multiple-Dose Protocol

• Chang HJ
• Lee JR
• Jee BC
• Suh CS
• Kim SH
• Seoul National University College of Medicine Assisted Reproductive Technology (SMART) Study Group

• KMID: 1779128
• DOI: http://doi.org/10.3346/jkms.2009.24.2.262

Abstract

This study was performed to analyze retrospectively outcomes of stimulated in vitro fertilization (IVF) cycles where the gonadotropin-releasing hormone (GnRH) antagonist was omitted on ovulation triggering day. A total of 92 consecutive IVF cycles were included in 65 women who are undergoing ovarian stimulation with recombinant FSH. A GnRH antagonist, cetrorelix 0.25 mg/day, was started when leading follicle reached 14 mm in diameter until the day of hCG administration (Group A, 66 cycles) or until the day before hCG administration (Group B, 26 cycles). The duration of ovarian stimulation, total dose of gonadotropins, serum estradiol levels on hCG administration day, and the number of oocytes retrieved were not significantly different between the two groups. The total dose of GnRH antagonist was significantly lower in Group B compared to Group A (2.7+/-0.8 vs. 3.2+/-0.9 ampoules). There was no premature luteinization in the subjects. The proportion of mature oocytes (71.4% vs. 61.7%) and fertilization rate of mature (86.3+/-19.7% vs. 71.8+/-31.7%) was significantly higher in Group B. There were no significant differences in embryo quality and clinical pregnancy rates. Our results suggest that cessation of the GnRH antagonist on the day of hCG administration during a flexible multiple-dose protocol could reduce the total dose of GnRH antagonist without compromising IVF results.

Keyword

GnRH Antagonist; hCG Administration; Oocyte Maturation; Fertilization; Ovulation Induction; Cetrorelix

MeSH Terms

Adult
Chorionic Gonadotropin/administration & dosage
Drug Administration Schedule
Estradiol/blood
Female
Fertilization in Vitro
Follicle Stimulating Hormone/administration & dosage/blood
Gonadotropin-Releasing Hormone/*antagonists & inhibitors
Hormone Antagonists/*administration & dosage
Humans
Ovulation Induction/*methods
Recombinant Proteins/therapeutic use
Retrospective Studies

Figure

• 

  Fig. 1 Schematic diagram of controlled ovarian hyperstimulation protocol. On the menstrual cycle day 3, recombinant FSH was started at adjusted dose individually. Once the largest follicle reached 14 mm in diameter, 0.25 mg of GnRH antagonist was started. 10,000 IU of urinary hCG (u-hCG) or 250 µg of recombinant hCG (r-hCG) was administrated when leading follicle reached 18 mm in diameter. GnRH antagonist was administered daily until the day of hCG administration (Group A) or the day before hCG administration (Group B).

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