Comparison of daily ganirelix administration to a long protocol agonist for controlled ovarian hyperstimulation in oocyte donors: The results of a prospective randomized controlled trial

Abstract

Objective: GnRH antagonists have demonstrated their effectiveness in ART by suppressing the endogenous LH surge. Some studies have suggested a trend toward lower implantation and pregnancy rates, albeit without achieving statistical significance. Researchers have postulated that there may be the potential for blockage of ovarian, endometrial, and embryonic GnRH receptors. This study compares the use of GnRH antagonists with mid-luteal depot GnRH agonists in donor oocyte cycles. Design: Prospective randomized controlled clinical trial. Materials and Methods: 29 oocyte donors were randomized to two groups. Group A had 17 donors that received 3.75 mg depot leuprolide acetate in the mid-luteal phase. Group B had 12 donors that received ganirelix 0.25 mg daily, starting when at least 2 follicles reached 12–14 mm diameter. All donors received OCPs the month prior to stimulation. All donors were started on 3–5 amps of rFSH, and 1 amp of hMG if their baseline LH were <0.5 mIU/mL. An additional amp of hMG was given daily upon starting ganirelix. HCG 10,000 U IM was given when at least two follicles reached 18–20 mm diameter. Each donor donated oocytes to 2–3 recipients. Recipients received 1.875 mg depot leuprolide acetate in the late luteal phase prior to endometrial preparation. Oral estradiol 6 mg/d and estradiol patch 0.1 mg/d were given until transfer. Progesterone in oil was given IM starting 3 days before transfer. ICSI was done on all mature oocytes. All transfers were done 3 days after ICSI. Results: Group A had 17 donors and 36 recipients. Group B had 12 donors and 26 recipients. Donor age, recipient age, and donor BMI were similar in both groups. There were no premature LH surges and no cancellations in either group. Peak E2, LH, and P4 levels were similar in both groups. The number of oocytes retrieved, mature oocytes, fertilized oocytes, embryos transferred, implantation rates, and clinical pregnancy rates were not statistically different between groups. (Table 1) Tabled 1 Conclusion: The GnRH antagonist ganirelix can achieve similar clinical efficacy compared to a long protocol with a depot GnRH agonist in donor oocyte cycles, suggesting no effect on embryo quality. Dissociating the GnRH antagonist from the recipient endometrium may account for the lack of a trend toward lower implantation and pregnancy rates in this study.