Use of gonadotropin-releasing hormone antagonists to overcome the drawbacks of intrauterine insemination on weekends

Abstract

Objective: To assess the usefulness of the GnRH antagonist cetrorelix to prevent LH surge and to avoid intrauterine insemination at weekends when a gynecologist on duty is not available and the ultrasound scan on Friday showed > 1 and < 3 follicles > or = 17 mm in diameter.

Design: Open-label, randomized, prospective study.

Setting: Reproductive medicine unit in an acute care teaching hospital in Barcelona, Spain.

Patient(s): Infertile patients undergoing controlled ovarian hyperstimulation (COH) and IUI.

Intervention(s): Treatment with recombinant FSH was started on day 3. In women assigned to the control group (n = 32), recombinant FSH was continued up to the day of hCG administration. In patients assigned to the GnRH antagonist group (n = 35), half of the dose of recombinant FSH was given for 2 more days in addition to cetrorelix (0.25 mg SC) until the day of hCG administration.

Main outcome measure(s): Recombinant FSH doses, E(2) level on the day of hCG administration, number and diameter of follicles, endometrial thickness, and number of pregnancies.

Result(s): Only a case of premature ovulation occurred in the cetrorelix group. There were no significant differences between the study groups in the total mean number of follicles, follicles > 10 mm and < 17 mm, and follicles > or = 17 mm. The mean concentration of E2 on the day of hCG administration and the endometrial thickness were significantly higher in the cetrorelix group. Eleven pregnancies were achieved, 7 (20%) in the cetrorelix group (4 singleton, 3 twins) and 4 (12.5%) in controls (4 singleton). No case of ovarian hyperstimulation syndrome (OHSS) occurred.

Conclusion(s): The use of cetrorelix to avoid IUI at weekends when the ultrasound scan on Friday shows > 1 and < 3 follicles > or = 17 mm is a useful alternative for medical centers in which a gynecologist on call is not available.