Fixed versus flexible antagonist protocol in women with predicted high ovarian response except PCOS: a randomized controlled trial.
BACKGROUND
No previous study directly compares the fixed day-5 initiation versus the flexible initiation of GnRH antagonist administration in IVF/ICSI for those patients who are predicted as high ovarian responders without PCOS. To evaluate whether the number of oocytes retrieved is different by using the two GnRH antagonist protocols in Chinese women with predicted high ovarian response except PCOS.


METHODS
A randomized controlled trial of 201 infertile women with predicted high ovarian response except PCOS undergoing in vitro fertilization. Ovary stimulation was performed using recombinant FSH and GnRH antagonists. GnRH antagonist ganirelix (0.25 mg/d) was started either on day 5 of stimulation (fixed group) or when LH was > 10 IU/L, and/or a follicle with mean diameter > 12 mm was present, and/or serum E2 was > 600 pg/ml. Patient monitoring was initiated on day 3 of stimulation in flexible group.


RESULT(S)
No significant difference was observed between the fixed and flexible groups regarding the number of oocytes retrieved (16.72 ± 7.25 vs. 17.47 ± 5.88, P = 0.421), the Gonadotropin treatment duration (9.53 ± 1.07 vs. 9.67 ± 1.03, P = 0.346) and total Gonadotropin dose (1427.75 ± 210.6 vs. 1455.94 ± 243.44, P = 0.381). GnRH antagonist treatment duration in fixed protocol was statistically longer than the flexible protocol (6.57 ± 1.17 vs 6.04 ± 1.03, P = 0.001). There was no premature LH surge in either protocol.


CONCLUSION(S)
Fixed GnRH antagonist administration on day 5 of stimulation appear to achieve a comparable oocyte retrieved compared with flexible antagonist administration.


TRIAL REGISTRATION
NCT02635607 posted on December 16, 2015 in clinicaltrials.gov.
['Luo|Xiu|X|', 'Pei|Li|L|', 'Li|Fujie|F|', 'Li|Chunli|C|', 'Huang|Guoning|G|', 'Ye|Hong|H|']
D000328:Adult D006063:Chorionic Gonadotropin D005260:Female D005307:Fertilization in Vitro D043373:Follicle Stimulating Hormone, Human D007987:Gonadotropin-Releasing Hormone D006801:Humans D007247:Infertility, Female D010053:Ovary D010062:Ovulation Induction D011085:Polycystic Ovary Syndrome D011247:Pregnancy D018873:Pregnancy Rate D011994:Recombinant Proteins D016896:Treatment Outcome D017329:Triptorelin Pamoate D055815:Young Adult
Number of oocytes retrieved In vitro fertilization Fixed protocol Flexible protocol Gonadotropin-releasing hormone antagonists