Cetrorelix protocol versus gonadotropin-releasing hormone analog suppression long protocol for superovulation in intracytoplasmic sperm injection patients older than 40

Objective

To determine which protocols work better between cetrorelix and long protocols in older patients in a randomized controlled study.

Design

A controlled randomized study in a single private IVF center.

Setting

Infertile women referred to a private IVF center.

Patient(s)

Five hundred sixty-four women 40 years or older undergoing IVF.

Intervention(s)

At their first IVF cycle, the women were randomized into two study groups using a computer-generated number sequence: 281 cases were treated with the cetrorelix protocol, and 283 patients were treated with a long protocol for controlled ovarian hyperstimulation.

Main Outcome Measure(s)

Days of stimulation, E₂ on the day of hCG administration, amount of FSH administered, number of oocytes yielded, number of embryos obtained, pregnancy rate, and implantation rate.

Result(s)

Patients treated with the long protocol showed a significantly higher number of oocytes retrieved and a higher pregnancy rate for both the cycle and transfer with respect to the cetrorelix protocol patients. The other parameter evaluated did not show any statistically significant differences.

Conclusion(s)

Our study showed that the long protocol performed better in older women than the cetrorelix protocol and that the GnRH antagonist may be detrimental in older women.

Key Words: GnRH antagonist, cetrorelix, long protocol, GnRH analog, IVF outcome, controlled ovarian hyperstimulation