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Effectiveness of Soft Stimulation Protocol, Compared with Conventional GnRH Antagonist Multiple dose Protocol in Patients Undergoing Controlled Ovarian Stimulation with Intrauterine Insemination  

Kim, Chung-Hoon (Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine)
Kang, Hyuk-Jae (Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine)
Kim, So-Ra (Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine)
Jeon, Gyun-Ho (Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine)
Lee, Hyang-Ah (Department of Obstetrics and Gynecology, Kangwon National University Hospital)
Kim, Sung-Hoon (Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine)
Chae, Hee-Dong (Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine)
Kang, Byung-Moon (Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine)
Publication Information
Clinical and Experimental Reproductive Medicine / v.37, no.2, 2010 , pp. 135-142 More about this Journal
Abstract
Objective: To evaluate the effectiveness of soft stimulation protocol using GnRH antagonist/clomiphene citrate (CC)/recombinant FSH (rFSH) in patients undergoing controlled ovarian stimulation (COS) with intrauterine insemination (IUI), compared with GnRH antagonist multiple dose protocol (MDP) using GnRH antagonist/rFSH. Methods: Eighty infertile women were randomized to soft stimulation protocol group (n=40) or GnRH antagonist MDP group (n=40). In both groups, IUI was performed 36~40 hours after hCG injection. Statistical analysis was performed using Student's t-test, $\chi^2$ test or Fisher's exact test as appropriate. Results: Total dose and days of rFSH required for COS were significantly fewer in soft stimulation protocol group (p<0.001, p<0.001). A premature LH surge did not occur in any patients of both groups. Clinical pregnancy rate per cycle was similar between the two groups. Conclusion: Soft stimulation protocol provides comparable pregnancy rates to GnRH antagonist MDP despite fewer total dose and days of rFSH, and so can become one of the patient-friendly, cost-effective alternatives for infertile patients undergoing COS with IUI.
Keywords
GnRH antagonist; Soft stimulation protocol; Controlled ovarian stimulation; Intrauterine insemination;
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1 Williams RS, Hillard JB, De Vane G, Yeko T, Kipersztok S, Rhoton-Vlasak A, et al. A randomized, multicenter study comparing the efficacy of recombinant FSH vs recombinant FSH with Ganirelix during superovulation/IUI therapy. Am J Obstet Gynecol 2004; 191: 648-51.   DOI   ScienceOn
2 Gomez-Palomares JL, Julia B, Acevedo-Martin B, Martinez- Burgos M, Hernandez ER, Ricciarelli E. Timing ovulation for intrauterine insemination with a GnRH antagonist. Hum Reprod 2005; 20: 368-72.   DOI
3 Lambalk CB, Leader A, Olivennes F, Fluker MR, Andersen AN, Ingerslev J, et al. Treatment with the GnRH antagonist ganirelix prevents premature LH rises and luteinization in stimulated intrauterine insemination: results of a double-blind, placebo-controlled, multicentre trial. Hum Reprod 2006; 21: 632-9.   DOI
4 Martikainen H, Ronnberg L, Ruokonen A, Kauppila A. Gonadotropin pulsatility in a stimulated cycle: clomiphene citrate increases pulse amplitudes of both luteinizing hormone and follicle-stimulating hormone. Fertil Steril 1991; 56: 641-5.   DOI
5 Diamond MP, Hill GA, Webster BW, Herbert CM, Rogers BJ, Osteen KG, et al. Comparison of human menopausal gonadotropin, clomiphene citrate, and combined human menopausal gonadotropin-clomiphene citrate stimulation protocols for in vitro fertilization. Fertil Steril 1986; 46: 1108-12.   DOI
6 Diedrich K, Diedrich C, Santos E, Zoll C, al-Hasani S, Reissmann T, et al. Suppression of the endogenous luteinizing hormone surge by the gonadotrophin-releasing hormone antagonist Cetrorelix during ovarian stimulation. Hum Reprod 1994; 9: 788-91.   DOI
7 Lehmann F, Baban N, Webber B. Ovarian stimulation for in-vitro fertilization: clomiphene and HMG. Hum Reprod 1988; 3(Suppl 2): 11-21.   DOI
8 Albano C, Felberbaum RE, Smitz J, Riethmuller-Winzen H, Engel J, Diedrich K, et al. Ovarian stimulation with HMG: results of a prospective randomized phase III European study comparing the luteinizing hormone-releasing hormone (LHRH)-antagonist cetrorelix and the LHRH-agonist buserelin. European Cetrorelix Study Group. Hum Reprod 2000; 15: 526-31.   DOI   ScienceOn
9 Felberbaum RE, Albano C, Ludwig M, Riethmuller-Winzen H, Grigat M, Devroey P, et al. Ovarian stimulation for assisted reproduction with HMG and concomitant midcycle administration of the GnRH antagonist cetrorelix according to the multiple dose protocol: a prospective uncontrolled phase III study. Hum Reprod 2000; 15: 1015-20.   DOI
10 Craft I, Gorgy A, Hill J, Menon D, Podsiadly B. Will GnRH antagonists provide new hope for patients considered 'difficult responders' to GnRH agonist protocols? Hum Reprod 1999; 14: 2959-62.   DOI   ScienceOn
11 Tavaniotou A, Albano C, Smitz J, Devroey P. Effect of clomiphene citrate on follicular and luteal phase luteinizing hormone concentrations in in vitro fertilization cycles stimulated with gonadotropins and gonadotropin-releasing hormone antagonist. Fertil Steril 2002; 77: 733-7.   DOI   ScienceOn
12 Engel JB, Ludwig M, Felberbaum R, Albano C, Devroey P, Diedrich K. Use of cetrorelix in combination with clomiphene citrate and gonadotrophins: a suitable approach to 'friendly IVF'? Hum Reprod 2002; 17: 2022-6.   DOI   ScienceOn
13 Albano C, Smitz J, Camus M, Riethmuller-Winzen H, Van Steirteghem A, Devroey P. Comparison of different doses of gonadotropin-releasing hormone antagonist Cetrorelix during controlled ovarian hyperstimulation. Fertil Steril 1997; 67: 917-22.   DOI   ScienceOn
14 Liu HC, Lai YM, Davis O, Berkeley AS, Graf M, Grifo J, et al. Improved pregnancy outcome with gonadotropin releasing hormone agonist (GnRH-a) stimulation is due to the improvement in oocyte quantity rather than quality. J Assist Reprod Genet 1992; 9: 338-44.   DOI   ScienceOn
15 Droesch K, Muasher SJ, Brzyski RG, Jones GS, Simonetti S, Liu HC, et al. Value of suppression with a gonadotropinreleasing hormone agonist prior to gonadotropin stimulation for in vitro fertilization. Fertil Steril 1989; 51: 292-7.   DOI