Half-Dose Depot Triptorelin Versus Reduced-Dose Daily Buserelin

Significant doubts remain about which type of GnRH agonists [GnRHa] administration to be used in controlled ovarian stimulation [COS] cycles. The use of a single-dose depot long-acting GnRHa instead of a daily low dose preparation would be more comfortable for patients, however, inducing a profound pituitary desensitization, it increases the number of gonadotropin ampoules and the duration of the COS cycle without improving pregnancy rates or other clinical outcomes. Thus, some authors recommend a reduction of both dose and/or duration of GnRHa administration. Halving the dose of depot triptorelin, for instance, has been studied against its full dose administration since 1992 with rather similar clinical outcomes. Half-dose depot leuprolide acetate has also resulted in comparable clinical outcomes with standard daily injections in long GnRHa protocol. Reducing the daily doses of short acting GnRHa has been advocated to demonstrate equivalent results to standard doses. To our knowledge, however, the reduced daily doses have not been evaluated against half dose depot forms in long GnRHa protocols.

Thus, we originally compared a half-dose depot triptorelin with reduced daily doses of short-acting buserelin in a long protocol for intracytoplasmic sperm injection and embryo transfer [ICSI/ET] cycles.

Inclusion criteria

• Candidate for ICSI/ET
• 35 years old or younger
• Serum FSH less than 10 IU/l on day three of the previous menstrual cycle
• No more than two previous IVF/ICSI attempts
• No planned percutaneous epididymal sperm aspiration [PESA]
• No planned testicular sperm extraction [TESE]
• No known history or risk of severe hyperstimulation
• No evidence of hydrosalpinx
• No major systemic disease
• No uterine abnormality
• No previous ovarian surgery