GnRH antagonists: improvement in clinical results needs a training period

Abstract

Objective: to assess the optimal use of GnRH antagonists in controlled ovarian stimulationDesign: A restrospective studyMaterials/Methods: We have assessed results on 386 patients. They were either patients having an history of poor response with GnRH agonist protocol or naive patients with an age greater than 38 and /or FSH greater than 10 IU/l. Patients were treated in 2 different periods. Period 1 : from September 2000 to December 2000, 201 patients were treated with GnRH antagonist ( Cetrorelix) single dose. Period 2 : from January 2001 to June 2001, 185 patients received GnRH antagonists ( Cetrorelix) multiple doses. In both groups, antagonists were combined with HMG and/or rec-hFSH. The starting dose of gonadotrophins was unchanged compared to our previous practice with agonists. Cetrotide 3 mg or 0.25 mg was introduced in the late follicular phase with at least 3 follicles having a diameter >or = 10 mm and/or an estradiol level >400 pg/ml. The efficacy criteria were the mean number of oocytes retrieved and inseminated.Results: Demographic characteristics ( age, basal FSH, LH and E2, BMI) were comparable in both groups. Only the mean ART attempt was significantly higher in the Cetrotide 0.25 mg group ( 3.5 vs 2.8, p <0.02). In both groups, E2 level on day of Cetrotide introduction and on day hCG are equivalent. In period 1 (Cetrorelix 3 mg), the mean number of oocytes retrieved increased from 8.2 to 10.6 within three months reaching a plateau. Similarly, in period 2 (Cetrorelix 0.25 mg), the mean number of oocytes retrieved increased from 4.7 to 9.9 within only 2 months. The same observation was made for the number of mature oocytes in both groups. When analysing Cetrorelix introduction, it appeared that from the beginning of each period to the end, the follicles diameter grew gradually from at least 3 follicles >or = 10 mm to 3 follicles >or = 13 mm.Conclusions: Our experience shows clearly that a new product of class has to be introduced in common practice with careful evaluation. The gradual increase in follicles diameter at Cetrorelix introduction shows the growing clinician confidence in preventing LH surge. Its major consequence is the increase of the mean number of oocytes retrieved and inseminated, first step of ART.Supported by: None. Objective: to assess the optimal use of GnRH antagonists in controlled ovarian stimulation Design: A restrospective study Materials/Methods: We have assessed results on 386 patients. They were either patients having an history of poor response with GnRH agonist protocol or naive patients with an age greater than 38 and /or FSH greater than 10 IU/l. Patients were treated in 2 different periods. Period 1 : from September 2000 to December 2000, 201 patients were treated with GnRH antagonist ( Cetrorelix) single dose. Period 2 : from January 2001 to June 2001, 185 patients received GnRH antagonists ( Cetrorelix) multiple doses. In both groups, antagonists were combined with HMG and/or rec-hFSH. The starting dose of gonadotrophins was unchanged compared to our previous practice with agonists. Cetrotide 3 mg or 0.25 mg was introduced in the late follicular phase with at least 3 follicles having a diameter >or = 10 mm and/or an estradiol level >400 pg/ml. The efficacy criteria were the mean number of oocytes retrieved and inseminated. Results: Demographic characteristics ( age, basal FSH, LH and E2, BMI) were comparable in both groups. Only the mean ART attempt was significantly higher in the Cetrotide 0.25 mg group ( 3.5 vs 2.8, p <0.02). In both groups, E2 level on day of Cetrotide introduction and on day hCG are equivalent. In period 1 (Cetrorelix 3 mg), the mean number of oocytes retrieved increased from 8.2 to 10.6 within three months reaching a plateau. Similarly, in period 2 (Cetrorelix 0.25 mg), the mean number of oocytes retrieved increased from 4.7 to 9.9 within only 2 months. The same observation was made for the number of mature oocytes in both groups. When analysing Cetrorelix introduction, it appeared that from the beginning of each period to the end, the follicles diameter grew gradually from at least 3 follicles >or = 10 mm to 3 follicles >or = 13 mm. Conclusions: Our experience shows clearly that a new product of class has to be introduced in common practice with careful evaluation. The gradual increase in follicles diameter at Cetrorelix introduction shows the growing clinician confidence in preventing LH surge. Its major consequence is the increase of the mean number of oocytes retrieved and inseminated, first step of ART. Supported by: None.