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

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: Čes. Gynek.2009, 74, č. 2 s. 75-80
Category: Original Article


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.

Randomized prospective pilot study.

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.

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.

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.


1. Comparable clinical outcome using the GnRH antagonist ganirelix or a long protocol of the GnRH agonist triptorelin for the prevention of premature LH surges in women undergoing ovarian stimulation. Hum Reprod, 2001, 16, p. 644-651.

2. Aboulghar, MA., Mansour, RT. Ovarian hyperstimulation syndrome: classifications and critical analysis of preventive measures. Hum Reprod Update, 2003, 9, p. 275-289.

3. Asch, RH., Li, HP., Balmaceda, JP., et al. Severe ovarian hyperstimulation syndrome in assisted reproductive technology: definition of high risk groups. Hum Reprod, 1991, 6, p. 1395-1399.

4. Borm, G., Mannaerts, B. Treatment with the gonadotrophin-releasing hormone antagonist ganirelix in women undergoing ovarian stimulation with recombinant follicle stimulating hormone is effective, safe and convenient: results of a controlled, randomized, multicentre trial. The European Orgalutran Study Group. Hum Reprod, 2000, 15, p. 1490-1498.

5. Brinsden, PR. A textbook of In Vitro Fertilization and Assisted Reproduction. New York: Parthenon Publishing, 1999, p. 131-155.

6. Daya, S. Gonadotrophin-releasing hormone agonist protocols for pituitary desensitization in in vitro fertilization and gamete intrafallopian transfer cycles. Cochrane.Database.Syst.Rev, 2007, CD001299.

7. Gardner, DK., Weissman, A., Howles, CM., et al. Textbook of Assisted Reproductive Techniques. London: Martin Dunitz, 2001, p. 464-469.

8. Griesinger, G., Diedrich, K., Devroey, P., et al. GnRH agonist for triggering final oocyte maturation in the GnRH antagonist ovarian hyperstimulation protocol: a systematic review and meta-analysis. Hum Reprod Update, 2006, 12, p. 159-168.

9. Haning, RV., Austin, CW., Carlson, IH., et al. Plasma estradiol is superior to ultrasound and urinary estriol glucuronide as a predictor of ovarian hyperstimulation during induction of ovulation with menotropins. Fertil Steril, 1983, 40, p. 31-36.

10. Kolibianakis, S. Agonists and Antagonists. Besins Healthcare, 2007, p. 38-42.

11. Koryntová, D. Indukce ovulace a kontrolovaná ovariální hyperstimulace. Mod gynek porod, 2002, 11, s. 525-530.

12. Mardešič, T. Indikace a výsledky léčby sterility metodami asistované reprodukce. Mod gynek porod, 2002, 11, s. 565-571.

13. Meirow, D., Schenker, JG., Rosler, A. Ovarian hyperstimulation syndrome with low oestradiol in non-classical 17 alpha-hydroxylase, 17,20-lyase deficiency: what is the role of oestrogens? Hum Reprod, 1996, 11, p. 2119-2121.

14. Morris, RS., Paulson, RJ., Sauer, MV., et al. Predictive value of serum oestradiol concentrations and oocyte number in severe ovarian hyperstimulation syndrome. Hum Reprod, 1995, 10, p. 811-814.

15. Ragni, G., Vegetti, W., Riccaboni, A., et al. Comparison of GnRH agonists and antagonists in assisted reproduction cycles of patients at high risk of ovarian hyperstimulation syndrome. Hum Reprod, 2005, 20, p. 2421-2425.

16. Rizk, B., Aboulghar, M. Modern management of ovarian hyperstimulation syndrome. Hum Reprod, 1991, 6, p. 1082-1087.

17. Rizk, B., Smitz, J. Ovarian hyperstimulation syndrome after superovulation using GnRH agonists for IVF and related procedures. Hum Reprod, 1992, 7, p. 320-327.

18. Tortoriello, DV., McGovern, PG., Colon, JM., et al. Critical ovarian hyperstimulation syndrome in a coasted in-vitro fertilization patient. Hum Reprod, 1998, 13, p. 3005-3008.

19. Zikopoulos, K., Kaponis, A., Adonakis, G. A prospective randomized study comparing gonadotropin- releasing hormone agonists or gonadotropin-releasing hormone antagonists in couples with unexplained infertility and/or mild oligozoospermie. Fertil Steril, 2009, 83, p. 1354-1362.

Paediatric gynaecology Gynaecology and obstetrics Reproduction medicine

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