Clinical Effects Of Different Doses Of Long-acting Gonadotropin Releasing Hormone Agonist(GnRH-a)Versus Daily Injections Of Short-acting GnRH-a In IVF Cycles

Purpose:Clinical efficacy was compared among single injections of different doses of long acting Gonadotropin Releasing Hormone Agonist (GnRH-a), and daily injections of short-acting GnRH-a in order to evaluate different methods of ovarian stimulation for in vitro fertilization (IVF) cycles.Methods:A retrospective study of214patients who underwent IVF assisted fertility treatments was conducted. Patients were allocated into four study groups:the short protocol (group A), in which daily injections of O.lmg GnRH-a was administered in the mid-luteal phase until the day of human chorionic gonadotropin (hCG) administration (see below); or the long protocol (group B, C&D), in which single injections of3.75mg,2.0mg, or0.9mg of long-acting GnRH-a was given in the mid-luteal phase, respectively. Stimulation with gonadotropins (Gn) started when pituitary down-regulation was established. When vaginal ultrasonographic scans showed that at least two follicles had reached16-20mm in diameter, Gn stimulation was withdrawn, and serum estradiol (E2), progesterone (P), and luteinizing hormone (LH) were determined. Additionally, human chorionic gonadotropin (hCG) was administered that evening. Egg collection was performed38hours after hCG injection and the standard IVF procedure was performed. Results:There were no statistically significant differences amongst the four groups in age,BMI, baseline concentrations of E2, LH and FSH, concentrations of E2during hCG administration,, the number of oocytes retrieved, the number of oocytes fertilized and embryos transferred, and clinical pregnancy rates. LH levels at hCG administration were significantly higher in group A and group D than group B and C(P<0.05).The total amount of Gn administered was almost identical when comparing group A and group D, as well as when comparing group B and group C. However, Group A and D required less Gn stimulation to exhibit follicles of16-20mm in diameter, compared to group B and C (P<0.05). Moreover, there was a significant difference in the time required for ovulation induction between group A and group C, where group A had a shorter time to ovulation. The fertilization rate was statistically different between group B and other groups (P<0.05). Overall, through our data analysis, we conclude based on outcome, cost, side-effects, and simplification of treatments, that the0.9mg long-acting GnRH-a treatment is eminent for ovarian stimulation for IVF.