Are gonadotropin-releasing hormone agonists losing popularity? Current trends at a large fertility center

Objective

To explore the long- and short-term trends in LH-suppression protocol use and patient profile characteristics.

Design

Descriptive study, retrospective cohort.

Setting

Large, university-based IVF center.

Patient(s)

Four thousand five hundred one fresh IVF cycles categorized by use of GnRH antagonist, luteal GnRH agonist, and follicular microdose GnRH agonist.

Intervention(s)

None.

Main Outcome Measure(s)

Frequency of use of LH-suppression protocol, patient and cycle characteristics, and outcomes at 10-year (1996–2005), 5-year (2001–5), and 3-year intervals (2004–6).

Result(s)

In both the <40 and ≥40 age groups, GnRH antagonist use increased from 2001 to 2005, while luteal GnRH agonist and microdose use decreased. The most recent luteal agonist patients were better responders and had higher implantation, clinical pregnancy, and delivery rates. Antagonist patients in the <40 and ≥40 age groups had a better response in 2005 than in 2001 with higher clinical pregnancy rates. Microdose patients responded worse in 2005 than in 2001, although pregnancy rates did not change significantly. Such trends were echoed from 2004 to 2006.

Conclusion(s)

The target population for GnRH antagonist has broadened to include younger, normal responders in addition to the traditional poor responder. Luteal agonist and microdose protocols are chosen less frequently and remain targeted toward good and poor responders, respectively.

Key Words: GnRH antagonist, GnRH agonist, poor responder, in vitro fertilization, LH suppression