Comparison of short 7-day and long gonadotropin -releasing hormone agonist protocols in the controlled ovarian stimulation for in vitro fertilization

Abstract

OBJECTIVE: To compare the effects on controlled ovarian stimulation and pregrancy outcomes of a short 7-day gonadotropin-releasing hormone agonist (GnRHa) protocol(7-day protocol)and a GnRHa long protocol (long protocol) as part of controlled ovarian stimulation regimens during in vitro fertilization and embroy transfer (IVF-ET) treatment. DESIGN: Prospective randomized controlled study. MATERIALS AND METHODS: One hundred and forty six infertile patients with tubal factor who accepted IVF-ET treatment from July to November 2007 were included in this study. 7-day protocol group (n=68): GnRHa (decapeptyl, Ferring) was injected 0.1 mg daily from day 2 of the menstrual cycle to day 8. At the same time gonadotropin (Gn) was injected daily from day 3. Long protocol group(n=78): GnRHa (diphereline, Ferring)was injected 1.88 mg singly in the mid-luteal phase of previous menstrual cycle. Once the patient was down regulated, gonadotropin injection was started. On the day of human chorionic gonadotrophin (hCG) injection, serum luteinizing hormone (LH), estradiol (E2) and progesterone (P) were measured by electrochemiluminescence immunoassay. RESULTS: The level of serum progesterone on the day of hCG injection was lower in the 7-day protocol group comparing with the long protocol group (0.58±0.51ng/ml vs 0.83±0.54ng/ml, P< 0.05).There were no significant differences in the levels of serum LH, E2, E2 per oocyte and E2 per mature follicle on the day of hCG injection. Patients in the 7-day protocol group were stimulated for a shorter period (8.97±1.45 d vs 11.41±1.43 d, P< 0.05), injected fewer Gn ampoules (1851.65±616.96 IU vs 2726.44±769.28 IU, P< 0.05),comparing with patients in the long protocol group. When comparing the results in the numbers of oocytes retrieved (14.74±6.72 vs 16.47±8.90), fertilization rate (77.94% vs 77.74%), cleaved embryos rate (94.11% vs 96.10%), top-quality embryos rate (60.68% vs 58.85%), implantation rate (25% vs 33.12%), pregnancy rate (50.00% vs 52.56%) and clinical abortion rate (5.88% vs 14.34%), the 7-day protocol group was similar to those of the long protocol group (P >0.05). CONCLUSIONS: The short 7-day GnRHa protocol and GnRHa long protocol had equal effects on controlled ovarian stimulation and pregrancy outcomes for in vitro fertilization and embroy transfer treatment. Patients who received the short 7-day GnRHa protocol required fewer ampoules of gonadotropin and shorter periods of treatment than those who received the GnRHa long protocol.