EVALUATION OF DIFFERENT OVARIAN STIMULATION PROTOCOLS FOR IN-VITRO FERTILIZATION

In this study we evaluated retrospectively the efficacy of five differ ent ovarian stimulation protocols in an in vitro fertilization program , in which 512 women were involved. Ovulation was induced by the follo wing protocols: group I (271 cycles): buserelin short protocol (1 mg/d ay, intranasally) with human menopausal gonadotropin/ human chorionic gonadotropin (hMG/hCG); group II (45 cycles): buserelin (shout protoco l) with pure follicle stimulating hormone (p-FSH)/hMG/hCG; group III ( 24 cycles): clomiphene citrate (100 mg/day) with hMG/hCG; group IV (12 2 cycles): hMG (3 amples/day) and hCG; group V (113 cycles): hMG/hCG a nd prednisolone (7.5 mg/day) after cycle programming with oval contrac eptives. The lowest cancellation rate (3.3%) was noted in group I, fol lowed by group V (9.7%). The highest number of follicles was observed in groups I (8.3 +/- 0.3; mean +/- SEM) and V (7.8 +/- 0.5). Also, mor e oocytes were retrieved in group I (7.2 +/- 9.3, p < 0.001), which we re of good quality based on oocyte maturity as well as on the fertiliz ation rate, and more embryos (4.5 +/- 0.3, p < 0.05) were developed. T he correlation between estradiol and the total follicular volume on th e day of hCG administration was also examined in the five groups. The best correlation (r = 0.6502) was found in group I, followed by group V (r = 0.5810). Significant differences were observed in the five grou ps with regard to the number of hMG ampules administered (p < 0.0001, F = 15.393) and the stimulation days (p < 0.0001, F = 35.32). Sixty-si x clinical pregnancies weve achieved: 37 (17.5%) in group I, seven (25 .9%) in group II, one (10%) in group III, ten (15.6%) in group IV and 11 (15.5%) in group V (differences were not statistically significant) . In conclusion, all five protocols were satisfactory in ovarian stimu lation for in vitro fertilization, and gonadotropin releasing hormone (GnRH) analogs seemed to be move advantageous by reducing the cancella tion rate, enhancing the number of oocytes retrieved and embryos devel oped and by improving the pregnancy rates.