A prospective randomized comparison of routine buserelin acetate and a decreasing dosage of nafarelin acetate with a low-dose gonadotropin-releasing hormone agonist protocol for in vitro fertilization and intracytoplasmic sperm injection

Objective: To compare the efficacy of a draw-back nafarelin acetate protoco l with routine buserelin acetate administration for in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). Design: Prospective clinical study. Setting: Mie University School of Medicine, Tsu, Mie, Japan. Patient(s): One hundred sixty-nine women treated with IVF and 183 women tre ated with ICSL. Interventions(s): Nafarelin acetate and buserelin acetate in ovarian hypers timulation in IVF and ICSI were administered. Main Outcome Measure(s): The concentrations of estradiol (E-2), FSH, LH, go nadotropin dosages; the number of oocytes retrieved, oocytes fertilized, an d embryos; and pregnancy rates. Result(s): A prospective study was conducted with 44 cycles for 34 couples with nafarelin acetate (group 1) and 47 cycles for 40 couples with busereli n acetate (group 2) with a long IVF protocol; 68 cycles for 46 couples with nafarelin acetate (group 3) and 56 cycles for 39 couples with buserelin ac etate (group 4) with a short IVF protocol; 39 cycles for 32 couples with na farelin acetate (group 5) and 50 cycles for 30 couples with buserelin aceta te (group 6) with a long ICSI protocol; and 87 cycles for 60 couples with n afarelin acetate (group 7) and 81 cycles for 61 couples with buserelin acet ate (group 8) with a short ICSI protocol. Patients were randomized to recei ve either fall-dose nafarelin acetate (200 mug b.i.d.) treatment for 7 days followed by half-dose nafarelin acetate (200 mug daily) or buserelin aceta te (300 mug t.i.d.). There were no statistically significant differences in baseline concentrations of E-2 and FSH, concentrations of E-2, P4, FSH, LH on hCG administration, gonadotropin dosage, the number of oocytes retrieve d and embryos transferred, or pregnancy rates between groups 1 and 2, group s 3 and 4, groups 5 and 6, and groups 7 and 8. Conclusion(s): Full-dose nafarelin acetate treatment for 7 days followed by half-dose nafarelin acetate ("draw-back" protocol) is an effective new pro tocol for IVF and ICSL (Fertil Steril(R) 2001;76:532-7. (C) 2001 by America n Society for Reproductive Medicine.).