Role of gonadotropin-releasing hormone antagonist in the management of subfertile couples with intrauterine insemination and controlled ovarian stimulation

Objective: To assess whether the clinical pregnancy rate of patients treated with recombinant FSH and IUI can be improved by the addition of a GnRH antagonist. Design: Prospective, controlled study. Setting: Reproductive medicine clinic. Patient(s): Ninety-three patients with primary or secondary infertility. Intervention(s): Patients were allocated to controlled ovarian stimulation with recombinant FSH (50-150 IU/d) only (control group, n = 45) or to recombinant FSH (50-150 IU/d) plus ganirelix (0.25 mg/d, starting when the leading follicle was >= 16 mm; n = 48). A single insemination was performed 36 hours after hCG was given (10,000 IU, IM) in both groups. Both groups were allowed at least three cycles. Main Outcome Measure(s): Clinical pregnancy rate, premature luteinization rate, and follicular development. Result(s): Clinical pregnancy rate (22% vs. 11%), cumulative pregnancy rate (52% vs. 31%), and number of mature follicles (2.1 +/- 1.08 vs. 1.4 +/- 0.95) were statistically significantly higher in the ganirelix group compared with the control group. The premature luteinization rate was significantly lower in the ganirelix group (1.7% vs. 17.5%). Conclusion(s): The use of a GnRH antagonist in conjunction with controlled ovarian stimulation and IUI significantly increases pregnancy rates and reduces the incidence of premature luteinization. (Fertil Steril (R) 2011; 95:2024-8. (C) 2011 by American Society for Reproductive Medicine.)