PROSPECTIVE RANDOMIZED STUDY OF CLOMIPHENE CITRATE AND GONADOTROPINS VERSUS GOSERELIN AND GONADOTROPINS FOR FOLLICULAR STIMULATION IN ASSISTED REPRODUCTION

We performed a prospective randomized study of goserelin, a long-actin g gonadotrophin-releasing hormone agonist (GnRHa) and human menopausal gonadotrophin (HMG) versus clomiphene citrate and HMG for follicular stimulation in assisted reproduction to investigate whether the use of this GnRHa provides a clear advantage in terms of pregnancy per treat ment cycle in unselected patients, who entered a first trial of assist ed reproduction, From a retrospective analysis comparing the two stimu lation protocols, a relative increase of the pregnancy rate per cycle of 50% was anticipated, To detect this difference with a power of 90%, 300 patients had to be included, The main prognostic factors affectin g the outcome of assisted reproduction were equally divided among the two groups by a minimization procedure, The pregnancy rates per cycle were significantly better in the goserelin/HMG group than in the clomi phene citrate/HMG group, both for all procedures of assisted reproduct ion combined (36.8 versus 24.5%; P < 0.02) and for the main procedure of in-vitro fertilization (IVF) (37.0 versus 23.5%; P < 0.02), Differe nces in pregnancy rates per oocyte retrieval and per embryo transfer w ere less pronounced (37.8 versus 30.8%; P = 0.40 and 44.4 versus 36.8% ; not significant), On the other hand, stimulation with goserelin/HMG was associated with a higher number of ampoules of HMG (44.9 versus 9. 9; P < 0.0001), a longer duration of stimulation (11.2 versus 8.7 days ; P < 0.0001) and an incidence of ovarian stimulation of 4.5% (7/154) versus 0% in the clomiphene citrate/HMG group, Goserelin was well tole rated and proved to be very reliable as an adjunct of follicular stimu lation in assisted reproduction, The main determinants of the higher e fficacy of goserelin/HMG in assisted reproduction were the virtual abs ence of cancellation of the cycle and the increased number of oocytes.