Skip to main content

Advertisement

SpringerLink
Log in

Mild IVF using GnRH agonist long protocol is possible: Comparing stimulations with 100 IU vs. 150 IU recombinant FSH as starting dose

  • ASSISTED REPRODUCTION
  • Published:
Journal of Assisted Reproduction and Genetics Aims and scope Submit manuscript

Abstract

Purpose

To test the possibility of stimulating ovaries with a mild IVF approach using a GnRH agonist long protocol.

Methods

Retrospective study of 142 first IVF cycles of women aged 30 to 35 who had undergone stimulation with 100 IU or 150 IU of rFSH.

Results

The mean dose of rFSH used was smaller in the low dose compared with the high dose group (999 vs. 1343 IU; p < 0.001), obtaining comparable numbers of mature oocytes in both groups. Additionally, reducing the mean number of embryos transferred from 1.8 to 1.5 significantly decreased the twin rate in the low dose group while maintaining similar pregnancy rates in both groups.

Conclusions

It is possible to develop mild IVF using GnRH agonist long protocol in women with good prognosis. A reduced amount of rFSH and fewer transferred embryos allow for lower costs and risks of IVF without compromising the pregnancy rate.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Nargund G, Frydman R. Towards a more physiological approach to IVF. Reprod Biomed Online 2007;14:550–2.

    Article  PubMed  Google Scholar 

  2. Hassan-Ali H, Hisham-Saleh A, El-Gezeiry D, Baghdady I, Ismaeli I, Mandelbaum J. Perivitelline space granularity: a sign of human menopausal gonadotrophin overdose in intracytoplasmic sperm injection. Hum Reprod 1998;13:3425–30. doi:10.1093/humrep/13.12.3425.

    Article  PubMed  CAS  Google Scholar 

  3. Balakier H, Bouman D, Sojecki A, Librach C, Squire JA. Morphological and cytogenetic analysis of human giant oocytes and giant embryos. Hum Reprod 2002;17:2394–401. doi:10.1093/humrep/17.9.2394.

    Article  PubMed  Google Scholar 

  4. Magli MC, Ferraretti AP, Crippa A, Lappi M, Feliciani E, Gianaroli L. First meiosis errors in immature oocytes generated by stimulated cycles. Fertil Steril 2006;86:629–35. doi:10.1016/j.fertnstert.2006.02.083.

    Article  PubMed  Google Scholar 

  5. Hassold T, Hunt P. To err (meiotically) is human: the genesis of human aneuploidy. Nat Rev Genet 2001;2:280–91. doi:10.1038/35066065.

    Article  PubMed  CAS  Google Scholar 

  6. Munné S, Magil C, Adler A, Wright G, de Boer K, Mortimer D, et al. Treatment related chromosome abnormalities in human embryos. Hum Reprod 1997;12:780–4. doi:10.1093/humrep/12.4.780.

    Article  PubMed  Google Scholar 

  7. Baart EB, Martini E, Eijkemans MJ, Van Optal D, Beckers NGM, Verhoeff A, et al. Milder ovarian stimulation for in-vitro fertilisation reduces aneuploidy in the human preimplantation embryo: a randomised controlled trial. Hum Reprod 2007;22:980–8. doi:10.1093/humrep/del484.

    Article  PubMed  Google Scholar 

  8. Paulson RJ, Sauer MV, Lobo RA. Embryo implantation after human in vitro fertilization: importance of endometrial receptivity. Fertil Steril 1990;53:870–4.

    PubMed  CAS  Google Scholar 

  9. Basir GS. OWS, Ng EH and Ho PC: Morphometric analysis of the peri-implantation endometrium in patients having excessively high-oestradiol concentratrions after ovarian stimulation. Hum Reprod 2001;16:435–40. doi:10.1093/humrep/16.3.435.

    Article  PubMed  CAS  Google Scholar 

  10. Simón C, Dominguez F, Valbuena D, Pellicer A. The role of estrogen in uterine receptivity and blastocyst implantation. Trends Endocrinol Metab 2003;14:197–9. doi:10.1016/S1043-2760(03)00084-5.

    Article  PubMed  CAS  Google Scholar 

  11. Devroey P, Bourgain C, Macklon NS, Fauser BCJM. Reproductive biology and IVF: ovarian stimulation and endometrial receptivity. Trends Endocrinol Metab 2004;15:84–90. doi:10.1016/j.tem.2004.01.009.

    Article  PubMed  CAS  Google Scholar 

  12. Kolb BA, Paulson RJ. The luteal phase of cycles utilising controlled ovarian hyperstimulation and the possible impact of this hyperstimulation on embryo implantation. Am J Obs Gyn 1997;176:1262–9. doi:10.1016/S0002-9378(97)70344-2.

    Article  CAS  Google Scholar 

  13. Tavanitou A, Albano C, Smitz J, Devroey P. Impact of ovarian stimulation on corpus luteum function and embryonic implantation. Reprod Immunol 2002;55:123–30. doi:10.1016/S0165-0378(01)00134-6.

    Article  Google Scholar 

  14. Martínez-Conejero JA, Simón C, Pellicer A, Horcajadas JA. Is ovarian stimulation detrimental to the endometrium? Reprod Biomed Online 2007;15:45–50.

    PubMed  Google Scholar 

  15. Abramowicz JS, Archer DF. Uterine endometrial peristalsis—a transvaginal ultrasound study. Fertil Steril 1990;54:451–4.

    PubMed  CAS  Google Scholar 

  16. Lesny P, Killick SR, Tetlow RL, Robinson J, Maguiness SD. Uterine junctional zone contractions during assisted reproduction cycles. Hum Reprod Update 1998;4:440–5. doi:10.1093/humupd/4.4.440.

    Article  PubMed  CAS  Google Scholar 

  17. Killick S. Ultrasound and the receptivity of the endometrium. Reprod Biomed Online 2007;15:63–7.

    Article  PubMed  Google Scholar 

  18. Polinder S, Heijnen EMEW, Macklon NS, Habbema JDF, Fauser BJCM, Eijkemans MJC. Cost effectiveness of a mild compared with a standard strategy for IVF: a randomized comparison using cumulative term live birth as the primary endpoint. Hum Reprod 2008;23:316–23. doi:10.1093/humrep/dem372.

    Article  PubMed  CAS  Google Scholar 

  19. Nargund G, Fauser BCJM, Macklon NS, Ombelet W, Nygren K, Frydman R. The ISMAAR proposal on terminology for ovarian stimulation for IVF. Hum Reprod 2007;11:2801–4. doi:10.1093/humrep/dem285.

    Article  Google Scholar 

  20. Devroey P, Tournaye H, Van Steirteghem A, Hendrix P, Out HJ. The use of a 100 IU starting dose of recombinant FSH (Puregon) in in-vitro fertilization. Hum Reprod 1998;13:565–6. doi:10.1093/humrep/13.3.565.

    Article  PubMed  CAS  Google Scholar 

  21. Moon SY, Kim SH, Ku SY, Jee BC, Choi YM, Lee JY. The clinical efficacy and efficiency of a 100-IU starting dose of recombinant follicle stimulating hormone (Puregon®) in Korean women undergoing in vitro fertilization and embryo transfer. J Obstet Gynaecol Res 2003;29:174–9. doi:10.1046/j.1341-8076.2003.00096.x.

    Article  PubMed  CAS  Google Scholar 

  22. Out HJ, Lindenberg S, Mikkelsen AL, Eldar-Geva T, Healy DL, Leader A, et al. A prospective randomised doubled-blind clinical trial to study efficacy of a fixed dose of recombinant follicle stimulating hormone (Puregon) in woman undergoing ovarian stimulation. Hum Reprod 1999;14:622–7. doi:10.1093/humrep/14.3.622.

    Article  PubMed  CAS  Google Scholar 

  23. Fernández-Shaw S, Grande C, Gallego E, Rodríguez L, Mayoral M, Capmany G, et al. Procrin en protocolo largo de FIV. Comparación entre dos dosis. Rev Ib Fertil 2000;17:109–10.

    Google Scholar 

  24. Stadtmauer L, Ditkoff EC, Session D, Kelly A. High dosages of gonadotropins are associated with poor pregnancy outcomes after in vitro fertilization–embryo transfer. Fertil Steril 1994;61:1058–64.

    PubMed  CAS  Google Scholar 

  25. Ben Rafael Z, Benadiva CA, Ausmanas M, Barber B, Blasco L, Flickinger GL, et al. Dose of human menopausal gonadotropin influences the outcome of an in vitro fertilization program. Fertil Steril 1987;48:964–8.

    PubMed  CAS  Google Scholar 

  26. Wikland M, Bergh C, Borg K, Hillensjö T, Howles CM, Knutsson A, et al. A prospective, randomized comparison of two starting doses of recombinant FSH in combination with cetrorelix in women undergoing ovarian stimulation for IVF/ICSI. Hum Reprod 2001;16:1676–81. doi:10.1093/humrep/16.8.1676.

    Article  PubMed  CAS  Google Scholar 

  27. Out HJ, Rutherford A, Fleming R, Tay CCK, Trew G, Ledger W, et al. A randomized, double-blind, multicentre clinical trial comparing starting doses of 150 and 200 IU of recombinant FSH in women treated with the GnRH antagonist ganirelix for assisted reproduction. Hum Reprod 2004;19:90–5. doi:10.1093/humrep/deh044.

    Article  PubMed  Google Scholar 

  28. Out HJ, Bratt DD, Linsten B, Gurgan T, Bukulmez O, Gökmen O, et al. Increasing the daily dose of recombinant follicle stimulating hormone (Puregon) does not compensate for the age-related decline in retrievable oocytes after ovarian stimulation. Hum Reprod 2000;15:29–35. doi:10.1093/humrep/15.1.29.

    Article  PubMed  CAS  Google Scholar 

  29. Heijnen E, Marinus JC, De Klerck C, Polinder S, Beckers NGM, Klinkert ER, et al. A mild treatment for in-vitro fertilisation: a Randomised non-inferiority trial. Lancet 2007;369:743–9. doi:10.1016/S0140-6736(07)60360-2.

    Article  PubMed  Google Scholar 

  30. Edwards RG, Lobo R, Bouchard P. Time to revolutionize ovarian stimulation. Hum Reprod 1996;11:917–9.

    PubMed  CAS  Google Scholar 

Download references

Acknowledgements

The authors would like to thank M Villamarín Alvarez and O. García Parra for their assistance in collecting data.

Author information

Authors and Affiliations

  1. URH-García del Real, Ana Teresa 30, 28023, Madrid, Spain

    Sylvia Fernández-Shaw, Nuria Pérez Esturo, Rosa Cercas Duque & Isabel Pons Mallol

Authors
  1. Sylvia Fernández-Shaw
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nuria Pérez Esturo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rosa Cercas Duque
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Isabel Pons Mallol
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sylvia Fernández-Shaw.

Additional information

Capsule Young women with good prognosis respond to 100 IU rFSH in a similar manner to 150 IU rFSH allowing for a lower cost of IVF.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Fernández-Shaw, S., Pérez Esturo, N., Cercas Duque, R. et al. Mild IVF using GnRH agonist long protocol is possible: Comparing stimulations with 100 IU vs. 150 IU recombinant FSH as starting dose. J Assist Reprod Genet 26, 75–82 (2009). https://doi.org/10.1007/s10815-008-9289-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10815-008-9289-z

Keywords

Search

Navigation