Prospective comparison of short and long GnRH agonist protocols using recombinant gonadotrophins for IVF/ICSI treatments

Abstract

This is a prospective comparative study investigating cost and effectiveness of IVF/ intracytoplasmic sperm injection (ICSI) treatments after stimulation with recombinant gonadotrophins following either the short or long gonadotrophin-releasing hormone (GnRH) agonist protocol. Patients in the short protocol (n = 120) were administered buserelin nasal sprays from day 2 of the menstrual cycle and recombinant FSH from day 5. Patients in the long protocol (n = 120) were administered buserelin from the previous mid-luteal phase and recombinant FSH after achieving down-regulation. The average age and basal FSH concentrations of both groups were similar. The serum LH concentrations during ovarian stimulation were significantly higher with the short protocol. The total cost of recombinant gonadotrophins (US$527 +/- 184 versus US$795 +/- 244, P < 0.001) was significantly lower in the short protocol, but there was no significant difference in delivery rates (47.5 versus 36.7%) between the short and long protocols. LH flare-up during the short protocol does not seem to impair the treatment outcome. Using recombinant gonadotrophins, the short GnRH agonist protocol is an effective and cheaper choice for IVF/ICSI treatments.

Cost-effectiveness of different types of COH protocols for in vitro fertilization at national level

“…[8,9]. Other cost-effectiveness analyses have found that the cost of COH and IVF outcomes also depend on the clinical choice of medicines and GnRHagonist/GnRH-antagonist for ovarian stimulation and the duration of stimulation [10][11][12][13][14][15][16][17]. For evaluation of the protocols in many of these studies, the clinical end-point of interest is the number of live-born children.…”

Modified Fixed Two Step Short Protocol versus Classic Short Protocol in ICSI

“…Although follicular growth can be induced by FSH in the total absence of LH, the resulting follicles have developmental deficiencies such as abnormally low production of E2 and an inability to luteinize and rupture in response to hCG stimulus [7][8][9][10][11][12].…”

“…LH flare-up during the short protocol does not seem to impair the treatment outcome using recombinant gonadotrophins. The short GnRH agonist protocol is an effective and cheaper choice for IVF/ICSI treatments [12].…”

A prospective randomised study comparing a GnRH-antagonist versus a GnRH-agonist short protocol for ovarian stimulation in patients referred for IVF

“…Different studies (Frydman et al, 1988a(Frydman et al, , 1988bHo et al, 2008) showed no difference in delivery rate between short and long GnRH agonist protocols.…”