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Korean Journal of Reproductive Medicine 2009;36(1):63-70.
Published online March 1, 2009.
Minimal Stimulation using rhFSH and GnRH Antagonist for IVF Treated Patients of Advanced Age.
So Ra Kim, Chung Hoon Kim, Jin Kyoung Lee, Gyun Ho Jeon, Sung Hoon Kim, Hee Dong Chae, Byung Moon Kang
Department of Obstetrics and Gynecology, College of Medicine, University of Ulsan, Asan Medical Center, Korea.
Abstract
OBJECTIVE
This study was performed to investigate the effectiveness of minimal stimulation using rhFSH and GnRH antagonist compared with GnRH antagonist multidose protocol (MDP) in IVF treated patients with aged 40 and above. METHODS: Seventy-five patients with aged 40 and above were equally randomized to minimal stimulation group (n=37) or GnRH antagonist MDP group (n=38). For minimal stimulation group, ultrasound monitoring was started on cycle day 7 or 8. Daily injections of 0.25 mg cetrorelix together with 150 IU rhFSH were started from the day at 13~14 mm of a leading follicle diameter. For GnRH antagonist MDP group, daily injections of 225 IU rhFSH were initiated from cycle day 2 and GnRH antagonist was started at a dose of 0.25 mg/day on rhFSH stimulation day 6 or the day at 13~14 mm of leading follicle diameter. In both groups, transvaginal ultrasound-guided oocyte retrieval was performed. According to cleavage and morphologic characteristics of embryos, embryos were transferred 3 to 5 days after oocyte retrieval. RESULTS: There were no differences in patients' characteristics and cycle cancellation rate between the two groups. Total dose and duration of rhFSH used were significantly fewer and shorter in minimal stimulation group than those in GnRH antagonist MDP group. The numbers of oocytes retrieved, mature oocytes and transferred embryos were also lower in minimal stimulation group. However, there were no significant differences in the clinical pregnancy rate and miscarriage rate between the two groups. CONCLUSIONS: This study demonstrates that minimal stimulation protocol provides comparable pregnancy rates to GnRH antagonist MDP with fewer dose and days of rhFSH used, and thus can be a cost-effective alternative in women aged 40 and above.
Key Words: Minimal stimulation protocol; Pregnancy rate; IVF; Advanced age
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