SHOULD GONADOTROPIN-RELEASING-HORMONE DOWN-REGULATION THERAPY BE ROUTINE IN IN-VITRO FERTILIZATION

Objective: To compare the classic clomiphene citrate (CC) and hMG regi me for ovarian stimulation before IVF in women who received hMG post-l ong protocol down-regulation with either 3 mg triptorelin [INN] IM or 150 mg buserelin acetate four times daily intranasally. Furthermore, i f possible, to determine the preferred method of down-regulation. Desi gn: A prospective study of 150 women randomized blind to the clinician to one of three alternative ovarian stimulation regimes when passing for the first time through an IVF program during 1992. Results: Tripto relin [INN] down-regulated significantly more quickly than buserelin a cetate. The non-down-regulated group CC and hMG used significantly les s hMG in a shorter time. In these women LH levels at hCG administratio n were significantly higher. No other intergroup differences were foun d. Pregnancy and take-home baby rates for the overall study were, resp ectively, 32%:25% (per cycle) and 42%:33%; (per ET) for the triptoreli n [INN] group 28%:22% and 39%:31%; the CC group 32%:24% and 46%:34%; a nd the buserelin acetate group 34%:28% and 42%:34%. Conclusions: Tript orelin [INN] and buserelin acetate were comparable in all parameters e xcept down-regulation. The former was significantly quicker and more s ure. In none of the clinical end points measured, however, was the cla ssic CC and hMG non-down-regulation regime significantly less effectiv e or troublesome than where down-regulation was used. These results th erefore show that although indications for down-regulation before IVF exist, it should not to be used on all patients.