Prospective comparison of short and long GnRH agonist protocols using recombinant gonadotrophins for IVF/ICSI treatments

This is a prospective comparative study investigating cost and effectiveness of IVF/ intracytoplasmic sperm injection (ICSI) treatments after stimulation with recombinant gonadotrophins following either the short or long gonadotrophin-releasing hormone (GnRH) agonist protocol.Patients in the short protocol (n = 120) were administered buserelin nasal sprays from day 2 of the menstrual cycle and recombinant FSH from day 5. Patients in the long protocol (n = 120) were administered buserelin from the previous mid-luteal phase and recombinant FSH after achieving down-regulation.The average age and basal FSH concentrations of both groups were similar.The serum LH concentrations during ovarian stimulation were significantly higher with the short protocol.The total cost of recombinant gonadotrophins (US$527 ± 184 versus US$795 ± 244, P < 0.001) was significantly lower in the short protocol, but there was no significant difference in delivery rates (47.5 versus 36.7%) between the short and long protocols.LH flare-up during the short protocol does not seem to impair the treatment outcome.Using recombinant gonadotrophins, the short GnRH agonist protocol is an effective and cheaper choice for IVF/ICSI treatments. Keywords: IVF, long GnRH agonist protocol, short GnRH agonist protocolThe use of gonadotrophin-releasing hormone (GnRH) agonists during IVF programmes helps prevent spontaneous LH surge, thus reducing cycle cancellation rate and improving treatment outcome (Hughes et al., 1992).Strategies for ovarian stimulation that combine gonadotrophins and GnRH agonists fall mainly into two categories, namely the 'short' and the 'long' protocols.Both protocols can effectively prevent spontaneous LH surges (Acharya et al., 1992), yet they are significantly different in terms of cycle dynamics.In the short protocol, the GnRH agonist is administered from day 2 of the cycle until the use of human chorionic gonadotrophin (HCG), then gonadotrophins are given 2-3 days after GnRH agonist initiation.The short protocol takes advantage of the initial stimulatory effect of GnRH agonist on pituitary gonadotrophin release (also known as the flareup effect) to promote follicular development.In the long protocol, the use of GnRH agonist starts in the mid-luteal phase of the pretreatment cycle to attain pituitary downregulation with suppression of endogenous gonadotrophin secretion.After suppression of the pituitary-ovarian axis, ovarian stimulation with exogenous gonadotrophins is commenced while GnRH agonist administration is continued concomitantly until the day of HCG administration.The question of which is superior between the long or the short Article Prospective comparison of short and long GnRH agonist protocols using recombinant gonadotrophins for IVF/ICSI treatments