A RANDOMIZED PROSPECTIVE-STUDY OF EARLY FOLLICULAR OR MIDLUTEAL INITIATION OF LONG PROTOCOL GONADOTROPIN-RELEASING-HORMONE IN AN IN-VITRO FERTILIZATION PROGRAM

Objective: to determine the optimum menstrual cycle time to initiate a long-protocol gonadotropin-releasing hormone agonist (GnRH-a) down-re gulation regimen before hMG stimulation before IVF. Design: Randomized , prospective, single, first cycle study. Setting: University teaching hospital. Patients: Eight-six infertile couples undergoing IVF-ET att empt under rules for Ireland. Intervention: Gonadotropin-releasing hor mone agonist administered intranasally from day 1 or 21 of menstrual c ycle. Human menopausal gonadotropin commenced when pituitary downregul ation was confirmed. Main Outcome Measures: Ovarian response, cancella tion, fertilization, and pregnancy rates. Results: No significant diff erences found between day 1 and day 21 initiation. But starting on day 1 is more easily recognizable by patients and avoids the possibility of administering GnRH-a in the presence of an unsuspected pregnancy. C onclusions: Both follicular and luteal phase initiation of GnRH-a long -protocol down-regulation are equally efficacious. In our clinical con text, patients and management favor commencing on day 1.