Early initiation of gonadotropin-releasing hormone antagonist treatment results in a more stable endocrine milieu during the mid- and late-follicular phases: a randomized controlled trial comparing gonadotropin-releasing hormone antagonist initiation on cycle day 2 or 6

Hamdine, O., Broekmans, F.J., Eijkemans, M.J., Lambalk, C.B., Fauser, B.C., Laven, J.S. and Macklon, N.S. (2013) Early initiation of gonadotropin-releasing hormone antagonist treatment results in a more stable endocrine milieu during the mid- and late-follicular phases: a randomized controlled trial comparing gonadotropin-releasing hormone antagonist initiation on cycle day 2 or 6. Fertility and Sterility, 100 (3), 867-874. (doi:10.1016/j.fertnstert.2013.05.031). (PMID:23809501)

Abstract

Objective: to compare the effect of initiating GnRH antagonist (GnRH-a) on cycle day (CD) 2 vs. CD 6 on LH, E2, and P levels in the mid and late follicular phases.

Design: nested study within a multicenter randomized controlled trial.

Setting: reproductive medicine center in an university hospital.

Patient(s): one hundred sixty patients undergoing IVF/intracytoplasmic sperm injection (ICSI).

Intervention(s): recombinant FSH (150–225 IU) was administered daily from CD 2 onward. The study group (CD 2) started GnRH-a cotreatment on CD 2, whereas the control group (CD 6) started on CD 6.

Main Outcome Measure(s): the follicular phase endocrine profile.

Result(s): the LH levels on CD 6 were lower in the CD 2 group (0.6 ± 0.4 vs. 1.9 ± 1.4 IU/L). The CD 2 group demonstrated both lower E2 levels on CD 6 (520.1 ± 429.6 pmol/L vs. 1,071.7 ± 654.2 pmol/L) and on the day of hCG administration (3,341.4 ± 1,535.3 pmol/L vs. 4,573.2 ± 2,445.4 pmol/L). The P levels did not differ on CD 6 or on the day of hCG administration.

Conclusion(s): early initiation of GnRH-a cotreatment results in a more stable endocrine profile, with more physiological levels of E2 and LH during the follicular phase. The effect on clinical outcomes must be established in larger trials

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