Clinical use of GnRH Antagonist in Minimal Stimulation Protocol for Assisted Reproductive Technologies

Jung, Jin Ho; Kim, Dong Ho; Lee, Sang Hoon

Abstract

OBJECTIVE
The Aim of this study to compare the clinical outcomes of GnRH antagonist (Cetrorelix) in minimal stimulation protocol for assisted reproductive technologies to that of GnRH agonist combined with long protocol.
METHODS
This study considered of 38 cycles was applied to 32 patients from Mar. 2001 to Feb. 2002. They were normoovulation patients and normal sperm. We excluded the poor responder for severe endometriosis women. The study group consisting of 16 patients was applied with 18 cycles of minimal protocol using GnRH antagonist. The control group consisting of 16 patients was applied with 20 cycles of long protocol using GnRH agonist.
RESULTS
The age and infertility duration of the study group were 34.2 +/- 2.8 years and 5.2 +/- 0.4 years each, whereas those of the control group were 33.8 +/- 3.2 years and 4.3 +/- 0.5 years respectively, thus showing insignificant difference between the two groups. E2 (pg/ml)/LH (mIU/ml)/FSH (mIU/ml), tested on the 3rd day of menstrual period as a baseline, of the study group were 18.4 +/- 3.4/8.4 +/- 1.2/6.3 +/- 0.8 respectively. Those of the control group were 19.2 +/- 2.5/7.8 +/- 0.7/6.8 +/- 0.6, which also were insignificantly difference from those of the study group. As for the hMG dosage, 24.5 +/- 3.5 amples were injected to the control group and a significant less dosage of 12.3 +/- 2.3 amples were injected to the study group (p<0.05). E2 level of the study on the hCG injection day was 864.3 +/- 34.5 (pg/ml) which was significantly less than 184.0 +/- 89.4 of the control group (p<0.05). The numbers of ovarian follicles on the ovum pick-up day were 4.2 +/- 1.2 and 8.6 +/- 2.4 for the study and control groups respectively. The number of embryo transferred in the study group was 3.8 +/- 0.5, which was less than 5.3 +/- 0.6 in the control group (p<0.05). However, there were no significant differences in the fertility and pregnancy rates. There were no premature LH surges in both groups. One case of abortion in 5 pregnancies of study group and one in 6 pregnancies of control group, whereas none of them were in the study group.
CONCLUSION
The minimal stimulation protocol using GnRH antagonist might be a simple, safe and effective method in the controlled ovarian hyperstimulation compared with GnRH agonist combined long protocol. The use of GnRH antagonist ended with less amples of gonadotropin, less complication even with similar clinical outcomes and efficacy, which was caused by long protocol using GnRH agonist.