J Korean Med Sci.  2008 Aug;23(4):662-666. 10.3346/jkms.2008.23.4.662.

Comparison of Clinical Efficacy between a Single Administration of Long-Acting Gonadotrophin-Releasing Hormone Agonist (GnRHa) and Daily Administrations of Short-Acting GnRHa in In Vitro Fertilization-Embryo Transfer Cycles

• Cheon KW
• Song SJ
• Choi BC
• Lee SC
• Lee HB
• Yu SY
• Yoo KJ

• KMID: 1785826
• DOI: http://doi.org/10.3346/jkms.2008.23.4.662

Abstract

This study was aimed to evaluate the efficacy of a single administration of long-acting gonadotrophin-releasing hormone agonist (GnRHa) as compared with daily administrations of short-acting GnRHa in controlled ovarian hyperstimulation (COH) for in vitro fertilization and embryo transfer (IVF-ET) cycles. The mean dosage of recombinant follicle-stimulating hormone (rFSH) required for COH (2,354.5+/-244.2 vs. 2,012.5+/-626.1 IU) and the rFSH dosage per retrieved oocyte (336.7+/-230.4 vs. 292.1+/-540.4 IU) were significantly higher in the long-acting GnRHa group (N= 22) than those in the short-acting GnRHa group (N=28) (p<0.05). However, the mean number of visit to the hospital that was required before ovum pick-up (3.3+/-0.5 vs. 22.2+/-2.0) and the frequency of injecting GnRHa and rFSH (12.8+/-1.2 vs. 33.5+/- 3.5) were significantly decreased in the long-acting GnRHa group (p<0.0001). The clinical pregnancy rate, implantation rate, and early pregnancy loss rate were not significantly different between the 2 groups. So, we suggest that a single administration of long-acting GnRHa is a useful alternative for improving patient's convenience with clinical outcomes comparable to daily administrations of short-acting GnRHa in COH for IVF-ET cycles.

Keyword

In Vitro Fertilization-Embryo Transfer; Long-Acting GnRHa; Goserelin; Recombinant FSH; Patient's Convenience

MeSH Terms

Adult
Buserelin/*therapeutic use
*Embryo Transfer
Female
*Fertilization in Vitro
Follicle Stimulating Hormone/therapeutic use
Goserelin/therapeutic use
Humans
Leuprolide/*therapeutic use

Reference

1. Loumaye E. The control of endogenous secretion of LH by gonadotrophin-releasing hormone agonists during ovarian hyperstimulation for in-vitro fertilization and embryo transfer. Hum Reprod. 1990. 5:357–376.

2. Smitz J, Van Den Abbeel E, Camus M, Devroey P, Tournaye H, Van Steirteghem AC. The effect of gonadotrophin-releasing hormone (GnRH) agonist in the follicular phase on in vitro fertilization outcome in normo-ovulatory women. Hum Reprod. 1992. 7:1098–1102.

3. Tummon IS, Daniel SA, Kaplan BR, Nisker JA, Yuzpe AA. Randomized, prospective comparison of luteal leuprolide acetate and gonadotropins versus clomiphene citrate and gonadotropin in 408 first cycles of in vitro fertilization. Fertil Steril. 1992. 58:563–568.

4. Dimitry ES, Bates SA, Oskarsson T, Margara R, Winston RM. Programming in vitro fertilization for a 5- or 3-day week. Fertil Steril. 1991. 55:934–938.

5. Polan ML, Daniele A, Russell JB, DeCherney AH. Ovulation induction with human menopausal gonadotropin compared to human urinary follicle-stimulating hormone results in a significant shift in follicular fluid androgen levels without discernible differences in granulosa-luteal cell function. J Clin Endocrinol Metab. 1986. 63:1284–1291.

6. Testart J, Forman R, Belaisch-Allart J, Volante M, Hazout A, Strubb N, Frydman R. Embryo quality and uterine receptivity in in-vitro fertilization cycle with or without agonists of gonadotrophin-releasing hormone. Hum Reprod. 1989. 4:198–201.

7. Tur-Kaspa I, Confino E, Dudkiewicz AB, Myers SA, Friberg J, Gleicher N. Ovarian stimulation protocol for in-vitro fertilization with gonadotropin-releasing hormone agonist widens the implantation window. Fertil Steril. 1990. 53:859–864.

8. Frydman R, Belaisch-Allart J, Parneix I, Forman R, Hazout A, Testart J. Comparison between flare up and down regulation effects of luteinizing hormone-releasing hormone agonist in an in vitro fertilization program. Fertil Steril. 1988. 50:471–475.

9. Abdalla HI, Ahuja KK, Leonard T, Morris NN, Honour JW, Jacobs HS. Comparative trial of luteinizing hormone-releasing hormone analog/human menopausal gonadotropin and clomiphene citrate/human menopausal gonadotropin in assisted conception program. Fertil Steril. 1990. 53:473–478.

10. Hughes EG, Fedorkow DM, Daya S, Sagle MA, Van de Kooppel P, Collins JA. The routine use of gonadotrophin-releasing hormone agonists prior to in-vitro fertilization and gamete intra-fallopian transfer: a meta-analysis of randomized controlled trials. Fertil Steril. 1992. 58:888–896.

11. Ron-El R, Herman A, Golan A, van der Ven H, Caspi E, Diedrich K. The comparison of early follicular and midluteal administration of long acting gonadotropin-releasing hormone agonist. Fertil Steril. 1990. 54:233–237.

12. Tan SL, Kingsland C, Campbell S, Mills C, Bradfield J, Alexander N, Yovich J, Jacobs HS. The long protocol of administration of gonadotropin-releasing hormone agonist is superior to the short protocol for ovarian stimulation for in vitro fertilisation. Fertil Steril. 1992. 57:810–814.

13. Oyesanya OA, Teo SK, Quah E, Abdurazak N, Lee FY, Cheng WC. Pituitary down-regulation prior to in-vitro fertilization and embryo transfer: a comparison between a single dose of Zoladex depot and multiple daily doses of Suprefact. Hum Reprod. 1995. 10:1042–1044.

14. Hsieh Y, Tsai H, Chang C, Lo H. Comparison of a single half-dose, long-acting form of gonadotropin-releasing hormone analog (GnRH-a) and a short-acting form of GnRH-a for pituitary suppression in a controlled ovarian hyperstimulation program. Fertil Steril. 2000. 73:817–820.

15. El-Nemr A, Bhide M, Khalifa Y, Al-Mizyen E, Gillott C, Lower AM, Al-Shawaf T, Grudzinskas JG. Clinical evaluation of three different gonadotrophin-releasing hormone analogues in an IVF programme: a prospective study. Eur J Obstet Gynecol Reprod Biol. 2002. 103:140–145.

16. Geber S, Sales L, Sampaio MA. Comparison between a single dose of goserelin (Depot) and multiple daily doses of leuprolide acetate for pituitary suppression in IVF treatment: a clinical endocrinological study of the ovarian response. J Assist Reprod Genet. 2002. 19:313–318.

17. Albuquerque LE, Saconato H, Maciel MC, Baracat EC, Freitas V. Depot versus daily administration of GnRH agonist protocols for pituitary desensitization in assisted reproduction cycles: a Cochrane review. Hum Reprod. 2003. 18:2008–2017.

18. Cheon KW, Byun HK, Yang KM, Song IO, Choi KH, Yoo KJ. Efficacy of recombinant human follicle-stimulating hormone in improving oocyte quality in assisted reproductive techniques. J Reprod Med. 2004. 49:733–738.

19. Wasser SK, Sewall G, Soules MR. Psychosocial stress as a cause of infertility. Fertil Steril. 1993. 59:685–689.

20. Pang SC. A pen injection device for self-administration of recombinant follicle-stimulating hormone for fertility treatments. Expert Rev Med Devices. 2005. 2:27–32.

21. Tapanainen J, Hovatta O, Juntunen K, Martikainen H, Ratsula K, Tulppala M, Tuomivaara L. Subcutaneous goserelin versus intranasal buserelin for pituitary down-regulation in patients undergoing IVF: a randomized comparative study. Hum Reprod. 1993. 8:2052–2055.

22. Tsai HD, Chen CM, Lo HY, Chang CC. Subcutaneous low dose leuprolide acetate depot versus leuprolide acetate for women undergoing ovarian stimulation for in-vitro fertilization. Hum Reprod. 1995. 10:2909–2912.

23. Dada T, Salha O, Baillie HS, Sharma V. A comparison of three gonadotrophin-releasing hormone analogues in an in-vitro fertilization programme: a prospective randomized study. Hum Reprod. 1999. 14:288–293.

24. Dal Prato L, Borini A, Trevisi MR, Bonu MA, Sereni E, Flamigni C. Effect of reduced dose of triptorelin at the start of ovarian stimulation on the outcome of IVF: a randomized study. Hum Reprod. 2001. 16:1409–1414.