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Hum. Reprod. Advance Access originally published online on January 19, 2009
Human Reproduction 2009 24(4):764-774; doi:10.1093/humrep/den468
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© The Author 2009. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

OPINION

Improving the patient's experience of IVF/ICSI: a proposal for an ovarian stimulation protocol with GnRH antagonist co-treatment

Paul Devroey1,10, Mohamed Aboulghar2, Juan Garcia-Velasco3, Georg Griesinger4, Peter Humaidan5, Efstratios Kolibianakis6, William Ledger7, Candido Tomás8 and Bart C.J.M. Fauser9

1 Center for Reproductive Medicine, Dutch-Speaking Brussels Free University, Laarbeeklaan 101, Brussels 1090, Belgium 2 The Egyptian IVF-ET Centre, Cairo University, 3 St 161, Hadaek El Maadi, Maadi, Cairo 1143, Egypt 3 Instituto Valenciano de Infertilidad Madrid, Madrid, Spain 4 Department of Obstetrics and Gynecology, University Clinic of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany 5 The Fertility Clinic, Viborg Hospital (Skive), Skive DK 7800, Denmark 6 Unit for Human Reproduction, 1st Department of Obstetrics and Gynaecology, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Nea Efkarpia Peripheral Road, Thessaloniki 54603, Greece 7 The Jessop Wing, Centre for Reproductive Medicine and Fertility, Sheffield Teaching Hospitals Trust, University of Sheffield, Sheffield S10 2SF, UK 8 AVA Clinic, Fertility Center, Tampere, Finland 9 Department of Reproductive Medicine and Gynecology, University Medical Center, Heidelberglaan 100 3584, CX, Utrecht, The Netherlands

10 Correspondence address. E-mail: paul.devroey{at}uzbrussel.be

Patients undergoing IVF/ICSI frequently experience substantial treatment burden, risk and psychological distress. These three related elements contribute to a negative patient experience that can lead to treatment discontinuation if pregnancy is not achieved. One approach to minimize these factors is the use of protocols designed to achieve high term, singleton birth rates per IVF treatment started, while improving the patient's welfare. Gonadotrophin-releasing hormone (GnRH) antagonists may be suitable for inclusion in such a protocol. In clinical trial data and meta-analyses, treatment with these agents is associated with similar live birth rates but reduced treatment burden (duration and side effects) and less risk of ovarian stimulation syndrome, compared with GnRH agonist long protocols. GnRH antagonists may also be associated with reduced psychological distress compared with agonists, but so far, the evidence for this is inconclusive. To facilitate the implementation of treatments that optimize the patient's experience, a simple GnRH antagonist protocol for use in predicted normal responders is proposed.

Key words: GnRH antagonist/IVF/ICSI/patient's experience/live birth rate


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