A COMPARISON OF 2 STARTING DOSES OF HUMAN MENOPAUSAL GONADOTROPIN FORFOLLICLE STIMULATION IN UNSELECTED PATIENTS FOR IN-VITRO FERTILIZATION

Ovarian responses and embryology data were compared in patients underg oing in-vitro fertilization following follicular stimulation using lon g course gonadotrophin-releasing hormone (GnRH) analogue/human menopau sal gonadotrophin (HMG) in which the initial daily dose was two (150 I U) or three ampoules (225 IU) maintained for a minimum of 7 days, Grou p 1 (n = 31; centre A) patients were treated with a starting dose of t wo ampoules, while group 2 (n = 46; centre A) patients were treated ch ronologically immediately before group 1 with a starting dose of three ampoules per day, Group 3 (n = 74; centre B) patients were treated wi th three ampoules per day simultaneously with group 1. There was no di fference in the distributions of patient ages or reasons for treatment between the three groups, Group 1 required longer treatment before th e plasma oestradiol attained 250 pg/ml than did both the other groups (group 1, 9.0; group 2, 6.9; group 3, 6.7 days; P < 0.01), and this re sulted in a longer follicular phase for group 1 (mean: 14.5 days compa red with 12.7 and 12.8 for groups 2 and 3 respectively; P < 0.05), The numbers of follicles >16 mm in diameter at human chorionic gonadotrop hin (HCG) administration and the numbers of eggs and embryos were all significantly lower (P < 0.04) in group 1, and cycle cancellations due to insufficient ovarian responses were higher (P < 0.02) in group 1, There was no difference in the numbers of ampoules used, the oestradio l concentration at HCG, the fertilization and pregnancy rates or the i ncidence of hyperstimulation syndrome in the three groups, The lower s tarting dose, therefore, yielded inferior responses without significan t reduction in the HMG requirement.