OBJECTIVE: To determine the optimum menstrual cycle time to initiate a long-protocol gonadotropin-releasing hormone agonist (GnRH-a) down-regulation regimen before hMG stimulation before IVF. DESIGN: Randomized, prospective, single, first cycle study. SETTING:University teaching hospital. PATIENTS: Eighty-six infertile couples undergoing IVF-ET attempt under rules for Ireland. INTERVENTION: Gonadotropin-releasing hormone agonist administered intranasally from day 1 or 21 of menstrual cycle. Human menopausal gonadotropin commenced when pituitary down-regulation was confirmed. MAIN OUTCOME MEASURES: Ovarian response, cancellation, fertilization, and pregnancy rates. RESULTS: No significant differences found between day 1 and day 21 initiation. But starting on day 1 is more easily recognizable by patients and avoids the possibility of administering GnRH-a in the presence of an unsuspected pregnancy. CONCLUSIONS: Both follicular and luteal phase initiation of GnRH-a long-protocol down-regulation are equally efficacious. In our clinical context, patients and management favor commencing on day 1.
RCT Entities:
OBJECTIVE: To determine the optimum menstrual cycle time to initiate a long-protocol gonadotropin-releasing hormone agonist (GnRH-a) down-regulation regimen before hMG stimulation before IVF. DESIGN: Randomized, prospective, single, first cycle study. SETTING: University teaching hospital. PATIENTS: Eighty-six infertile couples undergoing IVF-ET attempt under rules for Ireland. INTERVENTION: Gonadotropin-releasing hormone agonist administered intranasally from day 1 or 21 of menstrual cycle. Human menopausal gonadotropin commenced when pituitary down-regulation was confirmed. MAIN OUTCOME MEASURES: Ovarian response, cancellation, fertilization, and pregnancy rates. RESULTS: No significant differences found between day 1 and day 21 initiation. But starting on day 1 is more easily recognizable by patients and avoids the possibility of administering GnRH-a in the presence of an unsuspected pregnancy. CONCLUSIONS: Both follicular and luteal phase initiation of GnRH-a long-protocol down-regulation are equally efficacious. In our clinical context, patients and management favor commencing on day 1.
Authors: Judith A F Huirne; Cornelis B Lambalk; Andre C D van Loenen; Roel Schats; Peter G A Hompes; Bart C J M Fauser; Nick S Macklon Journal: Drugs Date: 2004 Impact factor: 9.546