Clinical outcomes and cycle characteristics of donor oocyte cycles using the GnRH analogues ganirelix or leuprolide

Abstract

Objective: Through suppression of the luteinizing hormone (LH) surge, gonadotropin-releasing hormone (GnRH) agonists dramatically decrease cancellation rates. GnRH antagonists also suppress the LH surge, but offer advantages over GnRH agonists. Antagonists are effective when administered only during the period when an LH surge is likely, allowing shorter stimulation protocols. This study compared the cycle characteristics and outcome in donor oocyte cycles stimulated with recombinant FSH and either ganirelix (Antagon, Organon, Inc. West Orange, NJ) or a long protocol of leuprolide (Lupron, TAP, Chicago, IL). Design: Case controlled study in a university affiliated IVF center. Materials/Methods: All donor oocyte cycles, including intracytoplamic sperm injection (ICSI), using ganirelix or a long protocol with leuprolide for LH suppression from January 1, 2001 through December 31, 2001 performed in a university-affliliated IVF center were evaluated. Thirty-one women began 32 cycles utilizing leuprolide followed by recombinant FSH. Twelve women underwent oocyte preparation with recombinant FSH and ganirelix began when follicular development reached 14 mm. All women were pretreated with oral contraceptives for 14–21 days. Cycle characteristics assessed included days and total dose of FSH, number of oocytes retrieved and fertilized. Implantation and clinical pregnancy rates were compared using the Chi-square and Fisher Exact Test, repectively. Results: Leuprolide was initiated in 32 cycles; 2 were cancelled due to poor stimulation. Twelve cycles were started and completed in the ganirelix group. No premature LH surges occurred. Mean duration of stimulation was 9.2 (SD 1.455) days in the leuprolide group and 9.4 (SD 1.261) with ganirelix. Median number of oocytes retrieved was 13.5 (SD 7.577) (range 3–35) with leuprolide and 16.5 (SD 5.233) (range 6–24) in the ganirelix group. Median number of oocytes fertilized were 9.0 (SD 4.715) and 10.0 (SD 3.576), respectively. The ganirelix group used on average 2400 IU FSH (SD 442.5) and 2100 IU FSH [SD 570.0 with leuprolide. Pregnancy occurred in 20/32 cycles (62.5%) in the leuprolide group and 6/12 (50%) ganirelix cycles [p = 0.48]. Within the agonist group, 78 embryos were transferred with ultrasound indentification of 28 gestational sacs, and an implantation rate of 35.9% The ganirelix group had an implantation rate of 38.0% [11 gestational sacs/ 29 embryos][p = 0.94]. Conclusions: Ganirelix is an effective method for LH suppression in donor cycles. When compared to cycles using the long protocol of leuprolide, donor oocyte cycles using ganirelix are shorter and produce similar pregnancy and implantation rates. Supported by: Partial support provided by Organon, Inc.