Long GnRH agonist vs. GnRH antagonist protocol in randomized controlled trial in unselected patients – hormonal and cycle characteristics – pilot study

Czech version

Authors: R. Středa ¹; T. Mardešič ¹; V. Sobotka ¹; J. Tošner ²
Authors‘ workplace: Sanatorium Pronatal, Praha, vedoucí lékař doc. MUDr. T. Mardešič, CSc. ¹; Gynekologicko-porodnická klinika, Fakultní nemocnice Hradec Králové, přednosta doc. MUDr. J. Tošner, CSc. ²
Published in: Ceska Gynekol 2009; 74(2): 75-80
Category: Original Article

Overview

Objective:
To evaluate hormonal and cycle characteristics (estradiol and LH level on day 5 and on the day of hCG administration) comparing long GnRH agonist vs. GnRH antagonist protocol for unselected patients.

Subject:
Randomized prospective pilot study.

Setting:
Sanatorium Pronatal, Praha.

Subject and method:
From January 2006 to June 2006 we randomized 40 unselected patients into GnRH agonist (triptorelin 0.1 mg) and GnRH antagonist (cetrorelix 0.25 mg) group. We recommended starting dose from 150 to 225 IU of rFSH or hMG based on the response to clomifencitrate treatment. We examined follicular growth on day 5 and on day 8 by transvaginal ultrasound and estradiol (E2) level on day 5 and on the day of hCG administration.

Results:
We randomized 21 patients in GnRH agonist and 19 patients in GnRH antagonist group. We proved E2 on day 5 (pg/ml) 269 ± 243 vs. 385 ± 293, LH on day 5 (IU/l) 1.7 ± 1.2 vs. 2.8 ± 1.4, E2 on the day of hCG administration (pg/ml) 1548 ± 1167 vs. 1397 ± 1076 (p<0.05) and LH on the day of hCG administration (IU/l) 2,2 ± 1.9 vs. 1.4 ± 1.1 (ns), endometrial thickness (mm) 10,6 ± 1,8 vs. 9,2 ± 0,9 (ns), total dose of FSH (IU) 1865 ± 517 vs. 1513 ± 357 (p<0.001), duration of FSH stimulation (days) 9.3 ± 1.6 vs. 7.8 ± 1.2 (p<0.001) in GnRH agonist vs. GnRH antagonist group, resp.

Conclusions:
There are significant differences in hormonal characteristics and cycle characteristics comparing both protocols (longer duration of treatment and higher consumption of gonadotropins, higher E2 levels on the day of hCG administration in GnRH agonist compared to GnRH antagonist group).

Key words:
ovulation induction, IVF, ICSI, gonadotropins, follitropin beta, estradiol, OHSS.

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