A prospective randomized comparison of routine buserelin acetate and a decreasing dosage of nafarelin acetate with a low-dose gonadotropin-releasing hormone agonist protocol for in vitro fertilization and intracytoplasmic sperm injection

Abstract

Objective: To compare the efficacy of a draw-back nafarelin acetate protocol with routine buserelin acetate administration for in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). Design: Prospective clinical study. Setting: Mie University School of Medicine, Tsu, Mie, Japan. Patient(s): One hundred sixty-nine women treated with IVF and 183 women treated with ICSI. Intervention(s): Nafarelin acetate and buserelin acetate in ovarian hyperstimulation in IVF and ICSI were administered. Main Outcome Measure(s): The concentrations of estradiol (E 2), FSH, LH, gonadotropin dosages; the number of oocytes retrieved, oocytes fertilized, and embryos; and pregnancy rates. Result(s): A prospective study was conducted with 44 cycles for 34 couples with nafarelin acetate (group 1) and 47 cycles for 40 couples with buserelin acetate (group 2) with a long IVF protocol; 68 cycles for 46 couples with nafarelin acetate (group 3) and 56 cycles for 39 couples with buserelin acetate (group 4) with a short IVF protocol; 39 cycles for 32 couples with nafarelin acetate (group 5) and 50 cycles for 30 couples with buserelin acetate (group 6) with a long ICSI protocol; and 87 cycles for 60 couples with nafarelin acetate (group 7) and 81 cycles for 61 couples with buserelin acetate (group 8) with a short ICSI protocol. Patients were randomized to receive either full-dose nafarelin acetate (200 μg b.i.d.) treatment for 7 days followed by half-dose nafarelin acetate (200 μg daily) or buserelin acetate (300 μg t.i.d.). There were no statistically significant differences in baseline concentrations of E 2 and FSH, concentrations of E 2, P4, FSH, LH on hCG administration, gonadotropin dosage, the number of oocytes retrieved and embryos transferred, or pregnancy rates between groups 1 and 2, groups 3 and 4, groups 5 and 6, and groups 7 and 8. Conclusion(s): Full-dose nafarelin acetate treatment for 7 days followed by half-dose nafarelin acetate (“draw-back” protocol) is an effective new protocol for IVF and ICSI.