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Korean Journal of Obstetrics & Gynecology 2004;47(2):269-277.
Published online February 1, 2004.
Clinical Efficacy of Reduced Dose GnRH Agonist Long Protocol for Controlled Ovarian Hyperstimulation in IVF-ET Patients with High Basal Serum FSH Level.
Young Sik Choi, Sun Mie Kim, Sang Don Kim, Dong Yun Lee, Byung Chul Jee, Seung Yup Ku, Chang Suk Suh, Young Min Choi, Jung Gu Kim, Shin Yong Moon, Seok Hyun Kim
1Department of Obstetrics and Gynecology, College of Medicine, Seoul National University, Seoul, Korea.
2Institute of Reproductive Medicine and Population, Medical Research Center, Seoul National University, Seoul, Korea.
Abstract
OBJECTIVE
To evaluate the clinical efficacy of half-dose and further reduced dose GnRH agonist long protocols for controlled ovarian hyperstimulation (COH) in in vitro fertilization and embryo transfer (IVF-ET) patients with high basal serum FSH level. METHODS: One hundred and two IVF-ET cycles performed in 84 infertile patients with high basal serum FSH level (FSH>10.0 mIU/mL) were included in this retrospective study. Study subjects were assigned in two groups: continuous half-dose GnRH agonist long protocol (Group A, n=63) vs. further reduced dose GnRH agonist long protocol (Group B, n=39) from half-dose at the start of GnRH agonist to 1/3 or 1/4 dose after pituitary suppression. Exogenous FSH or hMG was administered for COH in step-down mode, 4 or less embryos were transferred, and intramuscular progesterone or 8% progesterone gel was used for the luteal support. RESULTS: Serum estradiol (E2) level on hCG day was significantly higher in Group B (1,318.3 +/- 1,120.4 vs. 2,054.9 +/- 1,773.5 pg/mL, p=0.015). The number of transferable embryos was also significantly higher in Group B (2.9 +/- 1.7 vs. 3.7 +/- 2.0, p=0.027). There was no statistically significant difference in the outcomes such as the dose of gonadotropins administered, the number of oocytes retrieved, and the clinical pregnancy rate. CONCLUSION: GnRH agonist long protocol with the reduced dose from half-dose at the start to 1/3 or 1/4 of dose after pituitary suppression may be more beneficial for COH in IVF-ET patients with high basal serum FSH level. Further prospective randomized controlled study in a larger scale will be necessary to confirm this findings.
Key Words: In vitro fertilization and embryo transfer (IVF-ET), Controlled ovarian hyperstimulation (COH), GnRH agonist long protocol, Reduced dose


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