retrieval. All patients received luteal progesterone support. Stimulation characteristics and cyc... more retrieval. All patients received luteal progesterone support. Stimulation characteristics and cycle outcomes were reviewed and compared to a control group of 55 IVF cycles using a standard GNRH-a/gonadotropin downregulation stimulation also undergoing day 3 embryo transfer. Results: Fifty-five cycles using minimal COH resulted in 52 retrievals and 43 transfers. When compared to controls, there was no difference in mean patient age, the day of hCG administration, or the percentage of cycles with ICSI. Cycles using minimal COH used less medication (5.7 Ϯ 4.2 vs. 25.0 Ϯ 7.5 ampules, pϽ.05), had lower peak E2 levels (1523 Ϯ 749 pg/ml vs. 2443 Ϯ 1231 pg/ml, pϽ.05), and had fewer mature oocytes retrieved (3.7 Ϯ 2.0 vs. 13.1 Ϯ 6.0, pϽ.05) and embryos transferred (2.9 Ϯ 1.1 vs. 3.5 Ϯ 0.9, pϽ.05) when compared to cycles using the long protocol. However, clinical fresh pregnancy rates per transfer were equivalent in both groups (16/43, 37% vs. 21/51, 41%, pϭ.85 minimal COH vs. standard COH, respectively), as were ongoing pregnancy rates (13/43, 30% vs. 17/51, 33%, pϭ.92), and implantation rates (22/114, 19% vs. 31/175, 18%, pϭ.95). The risk of having no transfer was higher in the minimal stimulation group (16% (9/55) cancelled due to poor follicular growth; 5% (3/55) due to no embryos to transfer vs. 7% (4/55) overall for standard protocol). A premature luteinizing hormone surge occurred in only 5% of cycles (3/55). Only two cycles resulted in the freezing of excess embryos (4%). Costs including medication were 45% less in our setting for the patients undergoing minimal COH. Conclusion: IVF/ET using normal COH resulted in equivalent fresh pregnancy and implantation rates when compared to standard long COH, with a 45% reduction in cost to the patient. Disadvantages include the risk of cancellation due to a poor response and the lack of excess material for cryopreservation. Also the possibility of a premature LH surge exists, however the use of GNRH-antagonists in the future should eliminate this problem. Minimal COH is an attractive, affordable option for couples undergoing IVF.
retrieval. All patients received luteal progesterone support. Stimulation characteristics and cyc... more retrieval. All patients received luteal progesterone support. Stimulation characteristics and cycle outcomes were reviewed and compared to a control group of 55 IVF cycles using a standard GNRH-a/gonadotropin downregulation stimulation also undergoing day 3 embryo transfer. Results: Fifty-five cycles using minimal COH resulted in 52 retrievals and 43 transfers. When compared to controls, there was no difference in mean patient age, the day of hCG administration, or the percentage of cycles with ICSI. Cycles using minimal COH used less medication (5.7 Ϯ 4.2 vs. 25.0 Ϯ 7.5 ampules, pϽ.05), had lower peak E2 levels (1523 Ϯ 749 pg/ml vs. 2443 Ϯ 1231 pg/ml, pϽ.05), and had fewer mature oocytes retrieved (3.7 Ϯ 2.0 vs. 13.1 Ϯ 6.0, pϽ.05) and embryos transferred (2.9 Ϯ 1.1 vs. 3.5 Ϯ 0.9, pϽ.05) when compared to cycles using the long protocol. However, clinical fresh pregnancy rates per transfer were equivalent in both groups (16/43, 37% vs. 21/51, 41%, pϭ.85 minimal COH vs. standard COH, respectively), as were ongoing pregnancy rates (13/43, 30% vs. 17/51, 33%, pϭ.92), and implantation rates (22/114, 19% vs. 31/175, 18%, pϭ.95). The risk of having no transfer was higher in the minimal stimulation group (16% (9/55) cancelled due to poor follicular growth; 5% (3/55) due to no embryos to transfer vs. 7% (4/55) overall for standard protocol). A premature luteinizing hormone surge occurred in only 5% of cycles (3/55). Only two cycles resulted in the freezing of excess embryos (4%). Costs including medication were 45% less in our setting for the patients undergoing minimal COH. Conclusion: IVF/ET using normal COH resulted in equivalent fresh pregnancy and implantation rates when compared to standard long COH, with a 45% reduction in cost to the patient. Disadvantages include the risk of cancellation due to a poor response and the lack of excess material for cryopreservation. Also the possibility of a premature LH surge exists, however the use of GNRH-antagonists in the future should eliminate this problem. Minimal COH is an attractive, affordable option for couples undergoing IVF.
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