Comparison of outcome of clomiphene citrate/human menopausal gonadotropin/cetrorelix protocol and buserelin long protocol – a randomized study

Abstract

This study evaluates the efficacy of a stimulation protocol with clomiphene citrate (CC)/human menopausal gonadotropin (hMG)/cetrorelix and its effects on oocyte quality and endometrium. One hundred and twenty couples with male-factor infertility who were about to undergo their first intracytoplasmic sperm injection cycles were randomized into two groups. Sixty women were stimulated with the CC/hMG/cetrorelix protocol (cetrorelix group) and 60 received the buserelin long protocol (buserelin group). Fewer oocytes were recovered in the cetrorelix group than in the buserelin group (mean +/- standard deviation (SD): 11.1 +/- 4.0 vs. 17.3 +/- 5.8, p < 0.001); however, the percentages of metaphase II, metaphase I and germinal vesicle oocytes were similar between the two groups. Serum estradiol level was significantly lower in the cetrorelix than in the buserelin group (mean +/- SD: 2600.58 +/- 1189.11 vs. 3293.46 +/- 1221.49 pg/ml, p = 0.006), but the endometrial thickness was similar. The implantation rates (19.2% vs. 17.7%) and the pregnancy rates (41.7% vs. 40.0%) were similar between groups. The ampoules (mean +/- SD: 18.9 +/- 3.0 vs. 38.9 +/- 12.2, p < 0.001) and injections (mean +/- SD: 6.8 +/- 1.1 vs. 15.7 +/- 3.1, p < 0.001) of gonadotropin used were significantly lower in the cetrorelix group than in the buserelin group. No patients in either group developed a premature luteinizing hormone surge. The present study found no statistically significant difference between the two treatment modalities with regard to pregnancy rates.

“Mild” vs. “long” protocol for controlled ovarian hyperstimulation in patients with expected poor ovarian responsiveness undergoing in vitro fertilization (IVF): a large prospective randomized trial

“…These observations agree with previous reports, that showed that a high Gn dose is effective in getting more oocytes [8,24] and avoiding cycle cancellation [8], but does not improve IVF results [6][7][8]24]. This could be due to a negative impact of high Gn dose on endometrial quality [25] or, alternatively, to the fact that a high dose of exogenous Gn could force the recruitment of "resistant" follicles, hosting oocytes of poor quality from which poor competence embryos derive [26].…”

Effectiveness of cetrorelix for the prevention of premature luteinizing hormone surge during controlled ovarian stimulation using letrozole and gonadotropins: a randomized trial

“…This suggests that a daily dose level of 0.25 mg of cetrorelix may be too low and/or that the cetrorelix should be administered earlier to help prevent any upcoming premature LH surge among these patients. Previously, 2.5 mg of cetrorelix was administered when the leading follicle reached a size of 14 mm, and this successfully prevented premature LH surge in a COS protocol with CC and hMG during ICSI cycles (20,21). Further studies are needed to find the optimal timing and dosage for GnRH antagonist administration under the letrozole-FSH protocol.…”

Comparison of human menopausal gonadotropin stimulation with and without clomiphene forin-vitrofertilisation in poor-responders

“…In addition, Ingerslev et al (2001) conducted a randomised study comparing the natural cycle to the CC cycle and found a significantly higher ongoing pregnancy rate per cycle in the CC cycle than in the natural cycle (18.0% vs 3.5%, respectively). Moreover, in a study comparing 60 women who received CC ϩ hMG treatment and 60 who received the long protocol, pregnancy rates were similar between the groups (41.7% vs 40.0%, respectively) and signifi cantly fewer gonadotropin ampoules were used in the CC ϩ hMG group (Lin et al 2006). Comparing the CC and microdose GnRH agonist fl are protocols, Karimzadeh et al (2011) found similar cancellation and clinical pregnancy rates in both groups.…”