Pituitary suppression with a GnRHa short protocol in an alternate day schedule associated with rhCG microdoses

To evaluate a comfortable short protocol with GnRH agonist (GnRHa) in alternate days, with a step down method of gonadotropins administration associated with hCG microdose for young patients undergoing intracytoplasmic sperm injection.

This study evaluated 89 ICSI cycles performed in female patients aged <36 years. Patients were submitted to a short protocol with GnRHa schedule in the study group (n= 25) and to a long pituitary suppression protocol in the control group (n=64).

The total dose of rFSH administered as well as estradiol levels on the day of hCG trigger were significantly lower in the short protocol group. There were no significant differences between the groups regarding the fertilization, high-quality embryos, implantation, pregnancy and miscarriage rates. However, mean ovarian stimulation cost (GnRHa short group: $2,397 ± $870.3 and control group: $3,197 ± $658.9, P <0.001) and mean ovarian stimulation cost per pregnancy (GnRHa short group: ($4,993 ± $1,813 and control group: $9,743 ± $2,008, P <0.001) were significantly lower in the GnRHa short group as compared to the control group.

In patients with normal ovarian response, pituitary suppression with a GnRHa short protocol in alternate days is less costly, requires lower gonadotropins doses and results in similar implantation and pregnancy rates as compared to a GnRHa long protocol.