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Hum. Reprod. Advance Access published online on October 24, 2006
Human Reproduction, doi:10.1093/humrep/del416
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© The Author 2006. 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 The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that: the original authorship is properly and fully attributed; the Journal and Oxford University Press are attributed as the original place of publication with the correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions@oxfordjournals.org
Received July 11, 2006
Revised September 6, 2006
Accepted September 25, 2006

Article

Effect of GnRH antagonists in FSH mildly stimulated intrauterine insemination cycles: a multicentre randomized trial

P.G. Crosignani 1 *, E. Somigliana 2, on behalf of the Intrauterine Insemination (IUI) Study Group *

1 Università degli Studi di Milano, Fondazione IRCCS Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Milan, Italy
2 Infertility Unit, Fondazione IRCCS Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Milan, Italy

* To whom correspondence should be addressed.
P.G. Crosignani, E-mail: piergiorgio.crosignani{at}unimi.it


  Abstract

BACKGROUND: The usefulness of GnRH antagonists in mild controlled ovarian hyperstimulation (COH) and intrauterine insemination (IUI) cycles is debated. METHODS: Two-hundred and ninety-nine couples with unexplained or mild male factor infertility were enrolled in this international multicentre randomized controlled trial. Women allocated to the GnRH antagonist group (n = 148) received 50 IU recombinant FSH starting on day 3 of the menstrual cycle and Ganirelix 0.25 mg daily starting from the day in which a follicle with a mean diameter of 13-14 mm was visualized at ultrasound. Women allocated to the control group (n = 151) were administered only 50 IU recombinant FSH starting on day 3 of the menstrual cycle. Couples were recruited only for their first treatment cycle. The primary outcome was the clinical pregnancy rate per initiated cycle. RESULTS: Baseline characteristics of the two treatment groups were similar. Clinical pregnancy rates per initiated cycle in women who did and did not receive GnRH antagonists were 12.2 and 12.6%, respectively (P = 1.00). The relative risk of conception (95% confidence interval) for the use of GnRH antagonists was 1.0 (0.5-1.9). CONCLUSIONS: In mild COH and IUI cycles, any benefit of the use of GnRH antagonists in improving pregnancy rates is <2-fold increase.

Keywords: intrauterine insemination/mild ovarian hyperstimulation/GnRH antagonist.

*M.A.Aboulghar, The Egyptian IVF-ET Center, Cairo, Egypt; A.Allegra, Reproductive Medicine Unit, ANDROS Day Surgery, Palermo, Italy; R.Buxaderas, Reproductive Medicine Service, Institut Universitari Dexeus, Barcelona, Spain; V.Forgacs, Forgacs Institute of Assisted Reproduction, Budapest, Hungary; G.Griesinger, Department of Obstetrics-Gynaecology, University Clinic of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany; R.Homburg, Division of Reproductive Medicine, Vrije Universiteit Medical Center, Amsterdam, The Netherlands; M.Hrehorcak, Center of Reproductive Medicine and Reproductive Genetics, 2nd Medical Faculty, Charles University, Prague, Czech Republic; J.Konc, Infertility and IVF Center of Buda, St. John’s Hospital, Budapest, Hungary; L.Mamas, Neogenesis, IVF Center, Athens, Greece; G.Ragni, Infertility Unit, Fondazione IRCCS Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Milan, Italy; V.Silhan, Center of Assisted Reproduction SANUS, Hradec Kralove, Czech Republic.


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