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, E(2) 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.

Natural-cycle in vitro fertilization in poor responder patients: a survey of 500 consecutive cycles.

OBJECTIVE: To determine the role of the natural cycle for in vitro fertilization (IVF) in poor responder patients. DESIGN: Retrospective survey. SETTING: Private center for assisted reproduction. PATIENT(S): 294 women who were poor responders in a previous IVF cycle. INTERVENTION(S): Analysis of 500 consecutive natural cycles IVF. MAIN OUTCOME MEASURE(S): Number of cycles with oocytes, pregnancy rate per cycle, per transfer, and implantation rate. RESULT(S): Oocytes were found in 391 cases (78.1%), and cleaving embryos suitable for transfer were obtained in 285 cycles (57.0%). Pregnancy was observed in 49 cases, with a pregnancy rate of 9.8% per cycle, 17.1% per transfer, and 16.7% per patient. The patients were subdivided arbitrarily by the women's age into three groups. Patients 35 years old or younger showed a pregnancy rate of 18.1% per cycle, 29.2% per transfer, and 31.7% per patient. Women aged between 36 and 39 years showed a pregnancy rate of 11.7% per cycle, 20.6% per transfer, and 20.3% per patient. Women 40 years old or older showed a pregnancy rate of 5.8% per cycle, 10.5% per transfer, and 9.7% per patient. No differences were found for any of the evaluated parameters, independent of which cycle was the first, the second, third, fourth, or fifth, or further consecutive cycle. CONCLUSION(S): In poor responder patients, natural-cycle IVF is an effective treatment, especially in younger women.