Patient scheduling for gonadotrophin-releasing hormone antagonist protocols

Gonadotrophin-releasing hormone (GnRH) antagonists offer an alternative approach to the management of superovulation in assisted conception. Although several large multicentre randomized trials have provided information concerning the safety and efficacy of GnRH antagonists, their introduction into clinical practice has identified several new problems and opportunities. In vitro fertilization (IVF) practitioners with many years of experience of the 'long protocol' of pituitary downregulation with GnRH agonists have had to manage unfamiliar problems associated with patient scheduling and IVF cycle management when introducing GnRH antagonists into practice. Antagonist cycles require greater flexibility on the part of the IVF unit, with a need for 6 (or even 7) day working patterns and altered monitoring schedules. This article addresses the possibility of using oral contraceptives as part of GnRH antagonist cycle programming, and examines the definition of a 'good' cycle when using the antagonist.