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Human Reproduction, Vol. 15, No. 11, 2292-2296, November 2000
© 2000 European Society of Human Reproduction and Embryology

High doses of gonadotrophins combined with stop versus non-stop protocol of GnRH analogue administration in low responder IVF patients: a prospective, randomized, controlled trial

Juan A. Garcia-Velasco1,4, Verónica Isaza1, Antonio Requena1, Fco.Javier Martínez-Salazar1, Adriana Landazábal1, José Remohí2,3, Antonio Pellicer2,3 and Carlos Simón2,3

1 IVI-Madrid, Madrid, 2 Instituto Valenciano de Infertilidad (IVI) and 3 Department of Paediatrics, Obstetrics and Gynaecology, Valencia University School of Medicine, Valencia, Spain

Recent evidence suggests that early cessation of gonadotrophin releasing hormone analogue (GnRHa) administration may offer some benefit to low responder patients undergoing IVF. A prospective, randomized controlled trial was designed to evaluate whether early cessation of GnRHa in an ovarian stimulation regimen is more beneficial than just increasing the doses of gonadotrophins. Seventy low responder patients (less than three mature follicles in a previous cycle) with normal basal follicle stimulating hormone concentrations and a previous cancelled IVF cycle were randomly allocated into two protocols: (i) non-stop protocol: long GnRHa suppression with high doses of gonadotrophins, and (ii) stop protocol, in which GnRHa administration is stopped with the onset of menses, while gonadotrophin doses remained similar to the non-stop protocol. A significantly higher number of mature oocytes were obtained in the study group (stop protocol) compared to the control group (non-stop protocol) (8.7 ± 0.9 versus 6.2 ± 0.7, P = 0.027). The stop protocol reduced the number of ampoules of gonadotrophins required (56.6 ± 2.7 versus 68.0 ± 3.5, P = 0.013). Both protocols resulted in a similar cancellation rate (2.7 versus 5.8%) (with no cycles cancelled due to ovulation), pregnancy rate (14.3 versus 18.7%), and implantation rate (12.1 versus 8.8%). The early cessation of GnRHa combined with high doses of gonadotrophins permitted the retrieval of a significantly higher number of oocytes.

Key words: gonadotrophin/GnRH analogue/IVF/low responders

4 To whom correspondence should be addressed at: IVI-Madrid,C/Santiago de Compostela 88, 28035 Madrid, Spain.E-mail: ivimadrid{at}ivi.es


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