A retrospective comparison of microdose follicular phase and luteal phase gonadotropin releasing hormone agonist (GnRH-a) suppression for in vitro fertilization in patients 30 years old and younger

Abstract

Historically, microdose follicular phase agonist (MDF) use in IVF has been restricted to poor responders. In our program, we have used MDF more liberally because of its lower cost in a cost-contained military setting. Few studies have examined MDF in good prognosis patients. The objective of this study was to assess cycle outcome among ART patients ≤30 years receiving MDF or LL (luteal phase agonist) for LH surge suppression. Retrospective cohort study. After IRB approval, women ≤30 years undergoing their first, autologous ART cycle from 01/99–12/05 were evaluated. MDF or LL was determined based on pre-cycle screening. Both groups were pre-treated with oral contraceptive pills; LL and MDF groups underwent suppression as previously described (Leondires et al., 1999). Cycle characteristics and outcomes were evaluated using t-test and chi-square as appropriate; generalized estimating equations were used for multivariable models. 499 patients met inclusion criteria (LL = 287, MDF = 212). Pre-cycle/In-cycle characteristics and cycle outcomes are reported below (Table 1). Primary diagnosis differed between groups: LL had more ovulatory dysfunction while MDF had more unexplained infertility (P<0.001). No differences were seen in day 3 FSH, oocytes retrieved, oocyte maturity, fertilization rate or embryos transferred. In multivariable models, no significant differences were observed between the groups regarding implantation and live birth rates. Table 1Cycle characteristics and outcomes of MDF and LL among patients ≤30 yearsLL (n = 287)MDF (n = 212)P-valueMean (SD)Characteristics: Age (yrs)27.3 (2.0)28.6 (1.6)<0.001 Antral follicle count (n)17.7 (10.5)15.7 (9.3)0.04 Day 6 estradiol (pg/mL)623 (556)604 (647)NS Stimulation days (d)9.3 (0.1)9.8 (0.1)0.003 Peak estradiol (pg/mL)3797 (1934)3891 (1963)NS Total gonadotropins (amps)33.9 (11.8)39.9 (16.3)<0.001 Cycles cancelled (n)27 (9.4)23 (10.8)NS Assisted hatching (n)85420.007Outcome: Implantation rate (%)39.234.5NS Biochemical pregnancy (%)4.67.2NS Spontaneous abortion (%)4.34.3NS Clinical pregnancy (%)51.248.6NS Live birth (%)50.048.6NS Open table in a new tab MDF use in IVF yielded no differences in cycle outcome when compared to LL among good prognosis patients. Contrary to previous findings, MDF may be effectively used in good prognosis patients and has a potential cost savings advantage.