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Hum. Reprod. Advance Access originally published online on December 17, 2004
Human Reproduction 2005 20(3):616-621; doi:10.1093/humrep/deh668
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Human Reproduction Vol. 20 No. 3 © The Author 2004; all rights reserved

GnRH antagonist versus long GnRH agonist protocol in poor responders undergoing IVF: a randomized controlled trial

Lai-Ping Cheung1,2, Po-Mui Lam1, Ingrid Hung Lok1, Tony Tak-Yu Chiu1, Sum-Yee Yeung1, Ching-Ching Tjer1 and Christopher John Haines1

1 Department of Obstetrics and Gynecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China

2 To whom correspondence should be addressed: Email: lpcheung{at}cuhk.edu.hk

BACKGROUND. This is the first published report of a prospective, randomized, controlled trial comparing a fixed, multi-dose GnRH antagonist protocol with a long GnRH agonist protocol in poor responders undergoing IVF. METHODS. Sixty-six poor responders were randomized into two groups: the study group received 0.25 mg of cetrorelix daily starting on day 6 of stimulation; the control group received 600 µg of buserelin acetate daily starting in the mid-luteal phase of the preceding cycle. Both groups were given a fixed dose of recombinant FSH (300 IU daily) for stimulation. RESULTS. There were no significant differences in the cycle cancellation rates, duration of stimulation, consumption of gonadotrophins, and mean numbers of mature follicles, oocytes and embryos obtained. The implantation rates were similar, but the number of embryos transferred was significantly higher for the antagonist group (2.32±0.58 versus 1.50±0.83; P=0.01). The pregnancy rates were also higher in the antagonist group, but the difference was not statistically significant. CONCLUSION. A fixed multi-dose GnRH antagonist protocol is feasible for patients who are poor responders on a long agonist protocol; however, our study failed to demonstrate an overall improvement in ovarian responsiveness. Clinical outcomes may be improved by developing more flexible antagonist regimens, an approach that requires further evaluation.

Key words: GnRH agonist/GnRH antagonist/IVF/poor responder/randomized controlled trial


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