Single dose nasal spray of gonadotropin releasing hormone (GnRH) agonist effectively matures oocytes for in vitro fertilization in an ovarian stimulation protocol using clomiphene citrate, gonadotropin, and GnRH antagonist

Abstract

Objective: To investigate the efficacy of single dose nasal spray of gonadotropin releasing hormone (GnRH) agonist to mature oocytes for in vitro fertilization in a controlled ovarian stimulation protocol using clomiphene citrate, gonadotropin, and GnRH antagonist Design: Prospective, non-randomized clinical study at private clinics. Patients with repeated assisted reproduction technology failure were stimulated with clomiphene citrate, gonadotropin, and GnRH antagonist and allocated to either GnRH agonist nasal spray or intramuscular injection of human chorionic gonadotropin (HCG) for oocyte maturation. Outcome was measured by the number of oocytes retrieved and fertilized, and pregnancy rate. Materials and Methods: A total of 82 women who gave consent to receiving GnRH antagonist (Cetrorelix, Cetrotide, Serono, Switzerland) in their ovarian stimulation protocol were enrolled in the study. All patients received clomiphene citrate 100 mg/day from day 3 of menstrual period through day 7 and daily injection of 150–300 IU FSH/HMG commencing on day 4. Measurements of follicle diameter and serum E2 were initiated on menstrual day 8. When the leading follicle reached 14 mm in diameter, daily subcutaneous injection of 0.25 mg Cetrotide was initiated and continued until the day of GnRH agonist nasal spray or intramuscular HCG injection. When the leading follicle reached 20 mm in diameter, oocyte maturation was triggered by either 0.6 mg of single dose nasal spray of GnRH agonist (Buserelin, Sprecure, Aventis Pharma) (n = 40) or intramuscular injection of 10,000 IU HCG (n = 42). Oocyte retrieval was performed 36 hours after GnRH agonist/HCG administration. Only blastocysts were transferred on day 5 following oocyte retrieval. Pregnancy was defined as the visualization of gestational sac(s) at 6 weeks of gestation. Results: There was no difference in patient characteristics between the two groups. There was also no difference in the mean number of oocytes retrieved and those fertilized; 10.8 and 6.6, respectively, for the GnRH agonist group and 11.0 and 7.0 for the HCG group. Embryo transfer was possible in 38 and 39 cylces in the GnRH agonist group and HCG group, respectively, and an average of 2.2 and 2.3 blastocysts were transferred. A comparable pregnancy rate was achieved; 44.7% (17/38) for the GnRH agonist group and 53.8% (21/39) for the HCG group. Conclusion: Single dose nasal spray of GnRH agonist is as effective as intramuscular HCG injection to mature oocytes.