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A prospective randomized comparison between long and discontinuous-long protocols of gonadotropin-releasing hormone
1Department of Obstetrics and Gynecology, Hirosaki University School of Medicine, Aomori, Japan.
Objective:
To investigate the efficacy of a discontinuous-long protocol in an IVF program.
Design:
Prospective randomized study.
Setting:
University hospital.
Patient(S):
One hundred thirty-seven IVF cycles of 92 patients in an outpatient IVF program from April 1995 to December 1995.
Intervention(S):
In the discontinuous-long protocol group (n = 68), GnRH agonist (GnRH-a) was administered from the luteal phase until cycle day 7, when pure FSH administration was begun. In the long protocol group (n = 69), GnRH-a was administered until the day before hCG administration.
Main Outcome Measure(S):
Serum LH and ovarian steroid hormone levels, and IVF outcome.
Result(S):
The period and the total dosage of hMG were increased in the discontinuous-long protocol group. Although the fertilization rate was similar under both protocols, the number of embryos transferred was smaller and the cancellation rate was higher in the discontinuous-long protocol group because of the greater failure of oocyte retrieval and fertilization. Serum E2 levels in the late follicular phase were lower in the discontinuous-long protocol group.
Conclusion(S):
Early discontinuation of GnRH-a is not beneficial because of its adverse effects on follicular development.