Comparison of two different starting multiple dose gonadotropin-releasing hormone antagonist protocols in a selected group of in vitro fertilization-embryo transfer patients

Objective: To compare the efficacy of two starting protocols of multiple dose GnRH antagonists (GnRH-a). Design: Prospective randomized controlled study. Setting: In vitro fertilization- embryo transfer program at the Instituto Valenciano de Infertilidad, Valencia, Spain. Patient(s): One hundred nine patients undergoing controlled ovarian hyperstimulation (COH) with recombinant gonadotropins and GnRH-a (0.25 mg/d). Intervention(s): Patients started GnRH-a administration on stimulation day 6 (group 1) or when the leading follicle reached a mean diameter of 14 mm (group 2). Main Outcome Measure(s): Implantation and pregnancy rates; serum E-2 and LH levels during ovarian stimulation; days of stimulation and GnRH-a administration. Result(s): Days needed for ovarian stimulation were similar in both groups but there was a significant difference when comparing days of GnRH-a administration. Serum E, and LH followed similar curves in both groups. Implantation and pregnancy rates were 23.7% and 44.4 % in group I and 28.6% and 50.9 % in group 2 (P = not significant [NS]). Conclusion(s): The efficacy of the two starting protocols of the multiple dose GnRH-a evaluated in this study is similar; however, this remark can only be drawn for a selected group of patients.