A COMPARISON OF 2 STARTING DOSES OF HUMAN MENOPAUSAL GONADOTROPIN FOR FOLLICLE STIMULATION IN UNSELECTED PATIENTS FOR IN-VITRO FERTILIZATION

Ovarian responses and embryology data were compared in patients undergoing in-vitro fertilization following follicular stimulation using long course gonadotrophin-releasing hormone (GnRH) analogue/human menopausal gonadotrophin (HMG) in which the initial daily dose was two (150 IU) or three ampoules (225 IU) maintained for a minimum of 7 days, Group 1 (n = 31; centre A) patients were treated with a starting dose of two ampoules, while group 2 (n = 46; centre A) patients were treated chronologically immediately before group 1 with a starting dose of three ampoules per day, Group 3 (n = 74; centre B) patients were treated with three ampoules per day simultaneously with group 1. There was no difference in the distributions of patient ages or reasons for treatment between the three groups, Group 1 required longer treatment before the plasma oestradiol attained 250 pg/ml than did both the other groups (group 1, 9.0; group 2, 6.9; group 3, 6.7 days; P < 0.01), and this resulted in a longer follicular phase for group 1 (mean: 14.5 days compared with 12.7 and 12.8 for groups 2 and 3 respectively; P < 0.05), The numbers of follicles >16 mm in diameter at human chorionic gonadotrophin (HCG) administration and the numbers of eggs and embryos were all significantly lower (P < 0.04) in group 1, and cycle cancellations due to insufficient ovarian responses were higher (P < 0.02) in group 1, There was no difference in the numbers of ampoules used, the oestradiol concentration at HCG, the fertilization and pregnancy rates or the incidence of hyperstimulation syndrome in the three groups, The lower starting dose, therefore, yielded inferior responses without significant reduction in the HMG requirement.