SUBCUTANEOUS GOSERELIN VERSUS INTRANASAL BUSERELIN FOR PITUITARY DOWN-REGULATION IN PATIENTS UNDERGOING IVF - A RANDOMIZED COMPARATIVE-STUDY

One-hundred women undergoing ovarian stimulation with gonadotrophin-re leasing hormone agonist (GnRH-a) and a human menopausal gonadotrophin (HMG) for in-vitro fertilization (IVF) participated in this randomized comparative study. The effectiveness of long-acting s.c. goserelin (Z oladex depot; 49 patients) and intranasally (i.n.) administrated buser elin acetate (Suprefact; 51 patients) for pituitary down-regulation wa s compared. Treatment with s.c. goserelin (3.6 mg) or i.n. buserelin a cetate (200 mug; 6 times/day) was started on day 21-23 of the cycle. S timulation with 150 IU of HMG/day was started after at least 11 days o f GnRH-a treatment. There were no differences in the time required for follicular development nor in the clinical outcome between groups tre ated with either goserelin or buserelin. The number of oocytes recover ed in the goserelin group was 6.7 +/- 5.0 versus 6.3 +/- 4.9 in the bu serelin group. There were 11 pregnancies after the use of goserelin (2 2.4%) and 12 pregnancies in those given buserelin (24.0%). The number of HMG ampoules needed for follicular maturation was higher in the gos erelin group (27.9 +/- 7.8) than in the buserelin group (24.6 +/- 7.8, P < 0.05). The patients given buserelin suffered significantly more f rom tiredness, depression, headache and abdominal pain than those rece iving goserelin, whereas there were no differences between the groups in experiencing mental irritability, nausea and swelling. Subcutaneous goserelin depot injection offers a useful alternative for pituitary d own-regulation in IVF stimulation.