| Efficacy of controlled ovarian hyperstimulation using GnRH antagonist in women with polycystic ovary syndrome undergoing IVF-ET. |
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Jeong Won Choi, Chung Hoon Kim, Hyang Ah Lee, Seok Ho Hong, Hee Young Nah, Young Jin Lee, Sung Hoon Kim, Hee Dong Chae, Young Soo Son, Byung Moon Kang |
1Department of Obstetrics and Gynecology, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, Korea. chnkim@amc.seoul.kr
2Department of Obstetrics and Gynecology, Chungju Sungmo Hospital, Chungju, Korea. |
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| Abstract |
OBJECTIVE
GnRH antagonist has been recently developed and has provided a new treatment option for controlled ovarian hyperstimulation (COH). However, the use of GnRH antagonist (GnRH-ant) has been hesitated in women with polycystic ovary syndrome (PCOS) due to their high levels of tonic luteinizing hormone (LH). This study was performed to evaluate the efficacy of 2 kinds of GnRH-ant multidose protocols (MDPs) in infertile women with PCOS undergoing IVF-ET, compared with standard GnRH agonist (GnRH-a) luteal long protocol (LP). METHODS: Sixty-five patients with PCOS, aged 24-38 years were recruited for this prospective study and they were randomized to undergo GnRH-ant MDP during early and late follicular phase (GnRH-ant MDPEL) (group 1), GnRH-ant MDP during late follicular phase (GnRH-ant MDPL) (group 2), or GnRH-a luteal LP (group 3). All of the subjects were pretreated with low dose monophasic oral contraceptives (OCs) and they were administered recombinant FSH for ovarian stimulation. RESULTS: There were no differences in serum concentrations of progesterone and endometrial thickness on the day of hCG injection among three groups but serum concentrations of estrogen are higher in group 3 (GnRH-a luteal LP) than other groups. Total dose and duration of rFSH used for COH were significantly higher in group 3 than those in group 1 or 2. Number of retrieved oocytes, grade I/II embryos, fertilized oocytes were significantly higher in group 3 than those in group 2 but there were no differences in any parameters including IVF results between group 1 and 3. No difference in ongoing pregnancy rate was found among 3 groups. CONCLUSION: The use of the GnRH-ant, especially during early and late stimulation period (GnRH-ant MDPEL) is as effective as GnRH-a LP and might be considered more advantageous because of the short-term and small dose application, and therefore GnRH-ant MDPEL could be cheaper alternative in COH for PCOS women undergoing IVF-ET. |
| Key Words:
Polycystic ovary syndrome, GnRH antagonist, Controlled ovarian hyperstimulation, IVF |
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