In vitro fertilization cycle medication administration: combining follicle-stimulating hormone with GnRH-agonist in a single injection.

Abstract

Objective: In vitro fertilization (IVF) treatment routinely involves the administration of follicle-stimulating hormone (FSH) and a GnRH-agonist (Lupron; TAP Pharmaceuticals, Deerfield, IL, USA). These medications are usually given in two, separate subcutaneous injections. In an effort to simplify the medication regimen and reduce patient discomfort, we implemented a single, combined administration of FSH and Lupron (in one subcutaneous injection) for most IVF treatment cycles. We then compared the data to see if there were any differences in select outcome variables. Design: A retrospective review of all IVF cycles initiated between January 1, 1999 and April 30, 1999. The data obtained were compared using Chi-square analyses and Student’s t-test with GraphPad Prism software, San Diego, CA, USA. P < 0.05 was considered to be statistically significant. Materials/Methods: Five hundred twenty six cycles were performed using a single, combined injection of FSH and Lupron, and 180 cycles were performed using two, separate injections. Variables analyzed included patient age, peak estradiol measurement, number of treatment days, daily gonadotropin dose, number of follicles >14 mm on the day of hCG administration, number of embryos transferred, implantation rate, clinical pregnancy rate, and delivered pregnancy rate. Results: There were no statistically significant differences in combined v. separate injection groups for age (36.13 and 36.34 years, respectively, p = 0.57), peak estradiol (1502.98 and 1638.38 pg/ml, respectively, p = 0.10), daily gonadotropin dose (281.47 and 263.23 units, respectively, p = 0.08), number of follicles >14 mm on the day of hCG administration (6.56 and 6.29, respectively, p = 0.33), number of embryos transferred (2.81 and 2.97, respectively, p = 0.13), and implantation rate (15.60% and 14.31%, respectively, p = 0.50). There was a statistically significant difference in the number of treatment days (13.24 and 12.80, respectively, p = 0.02). This was not felt to be clinically significant. No statistically significant difference existed for the overall clinical pregnancy rate (27.95% and 28.33%, respectively, p = 0.92) or delivered pregnancy rate (24.52% and 22.22%, respectively, p = 0.53). Conclusions: Combined FSH and Lupron administration simplifies the IVF treatment regimen and reduces patient discomfort with no detrimental effect on treatment outcome.