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Hum. Reprod. Advance Access published online on June 2, 2005
Human Reproduction, doi:10.1093/humrep/dei086
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© The Author 2005. 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@oupjournals.org
Received March 3, 2005
Revised April 10, 2005
Accepted April 18, 2005

Opinion

GnRH antagonists in ovarian stimulation: a treatment regimen of clinicians’ second choice? Data from the German national IVF registry

Georg Griesinger 1*, Ricardo Felberbaum 2, and Klaus Diedrich 1

1 Department of Obstetrics and Gynecology, University Clinic of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
2 Department of Obstetrics and Gynecology, Clinic Kempten-Oberallgaeu, Kempten, Germany

* To whom correspondence should be addressed.
Georg Griesinger, E-mail: georg.griesinger{at}frauenklinik.uni-luebeck.de


  Abstract

The place of GnRH antagonists in ovarian stimulation is controversial. Meta-analyses on studies comparing GnRH agonist and GnRH antagonist treatment regimens have suggested a comparatively lower efficacy of GnRH antagonists, which is likely to have influenced clinicians’ attitudes. This report describes GnRH antagonist utilization for ovarian stimulation in Germany from 2000-2003. Data from the national IVF registry were analysed. The majority of ovarian stimulation cycles are still performed in long GnRH agonist protocols, although a significant increase in GnRH antagonist usage has been noted (P < 0.0001). Two observations support the notion that GnRH antagonists are often utilized as a treatment option in cycles with an unfavourable a priori prognosis: (i) the proportion of GnRH antagonist cycles increases with cycle rank (P < 0.0001, {chi}2 for linear trend); and (ii) GnRH antagonist cycles are more often conducted in older patients as compared to GnRH agonist cycles (P < 0.0001). This has important implications for interpreting clinical performance of GnRH antagonists outside a research context.

Keywords: assisted reproductive technology; GnRH antagonist; IVF; ovarian stimulation; registry.
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