Hum. Reprod. Advance Access originally published online on June 30, 2004
Human Reproduction 2004 19(8):1713-1718; doi:10.1093/humrep/deh334
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The effect of an individualized GnRH antagonist protocol on folliculogenesis in IVF/ICSI
1 To whom correspondence should be addressed at: Centre for Reproductive Medicine, Department of Obstetrics and Gynaecology, Academic Medical Centre, University of Amsterdam, P.O.Box 22700, 1100 DE Amsterdam, The Netherlands. Email: m.h.mochtar{at}amc.uva.nl
BACKGROUND: The aim of this study was to assess the effect of an individualized GnRH antagonist regimen on folliculogenesis. METHODS: In a multicentre, randomized, clinical trial, IVF/ICSI patients were allocated to a standard regimen, in which they received daily 0.25 mg GnRH antagonist ganirelix (Orgalutran) from the 6th day of stimulation onward (fixed regimen n=102) or to an individualized regimen, in which IVF/ICSI patients received daily 0.25 mg GnRH antagonist starting on the day that the dominant follicle had reached a diameter of 
15 mm (flexible regimen n=103). The primary endpoint was to assess the difference in the total number of oocytes. RESULTS: The mean (SD) number of retrieved oocytes was not statistically significantly different: 9.4 (5.8) in the flexible group versus 9.7 (6.5) in the fixed group. The clinical and ongoing pregnancy rates were 22.7 and 21.8% respectively in the flexible group versus 33 and 31.1% in the fixed group [relative rate ratio 0.69 (95% confidence interval 0.44–1.08) and 0.7 (0.44–1.12) respectively]. CONCLUSION: The individualized flexible regimen did not result in an increase in the total number of oocytes obtained.
Key words: controlled ovarian stimulation/flexible start/follicle development/GnRH antagonist/IVF/ICSI
* R.E.Bernardus, Gooi Noord Hospital, Blaricum; C.J.C.M.Hamilton, H.van Krevel, Jeroen Bosch Hospital, Den Bosch; B.Leerentveld, Isala Clinics, Zwolle; Y.M.van Kasteren, Medical Center Alkmaar, Alkmaar; M.A.H.M.Wiegerinck, Máxima Medical Centre, Veldhoven; P.Flierman, H.V.Verhoeve, OnzeLieveVrouwe Gasthuis, Amsterdam; and M.H.Mochtar, F.van der Veen, Academic Medical Center, Amsterdam
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