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Human Reproduction, Vol. 10, No. 4, pp. 791-796, 1995
© 1995 European Society of Human Reproduction and Embryology

research-article

Endocrinology: Prospective randomized study of clomiphene citrate and gonadotrophins versus goserelin and gonadotrophins for follicular stimulation in assisted reproduction

Marc Dhont1, Alexandra Onghena, Tom Coetsier and Paul De Sutter

Department of Obstetrics and Gynaecology, University of Gent De Pintelaan 185, B-9000 Gent, Belgium

Correspondence: 1To whom correspondence should be addressed

We performed a prospective randomized study of goserelin, a long-acting gonadotrophin-releasing hormone agonist (GnRHa) and human menopausal gonadotrophin (HMG) versus clomiphene citrate and HMG for follicular stimulation in assisted reproduction to investigate whether the use of this GnRHa provides a clear advantage in terms of pregnancy per treatment cycle in unselected patients, who entered a first trial of assisted reproduction. From a retrospective analysis comparing the two stimulation protocols, a relative increase of the pregnancy rate per cycle of 50% was anticipated. To detect this difference with a power of 90%, 300 patients had to be included. The main prognostic factors affecting the outcome of assisted reproduction were equally divided among the two groups by a minimization procedure. The pregnancy rates per cycle were significantly better in the goserelin/HMG group than in the clomiphene citrate/HMG group, both for all procedures of assisted reproduction combined (36.8 versus 24.5%; P < 0.02) and for the main procedure of in-vitro fertilization (IVF) (37.0 versus 23.5%; P < 0.02). Differences in pregnancy rates per oocyte retrieval and per embryo transfer were less pronounced (37.8 versus 30.8%; P = 0.40 and 44.4 versus 36.8%; not significant). On the other hand, stimulation with goserelin/HMG was associated with a higher number of ampoules of HMG (44.9 versus 9.9; P < 0.0001), a longer duration of stimulation (11.2 versus 8.7 days; P < 0.0001) and an incidence of ovarian stimulation of 4.5% (7/154) versus 0% in the clomiphene citrate/HMG group. Goserelin was well tolerated and proved to be very reliable as an adjunct of follicular stimulation in assisted reproduction. The main determinants of the higher efficacy of goserelin/HMG in assisted reproduction were the virtual absence of cancellation of the cycle and the increased number of oocytes.

Key words: assisted reproduction/clomiphene citrate/GnRH agonist/goserelin/randomized trial


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