The purpose of this study is to evaluate the appropriate controlled ovarian hyperstimulation (COH) protocol in good prognosis patients undergoing IVF treatment. The stimulation characteristics of cycles which include ultrashort flare GnRH agonist combined with flexible multidose GnRH antagonist will be compared to the flexible multidose GnRH antagonist protocol. The investigators hypothesized that combining the stimulatory effect of GnRH agonists and immediate suppression of the GnRH antagonist in a unique protocol may be a valuable new COH strategy for IVF patients, resulting in improved ART outcome.
The ultrashort flare GnRH agonist combined with flexible multidose GnRH antagonist protocol during COH cycle resulted in a significantly higher clinical pregnancy rate in patients with poor embryo quality, with repeated IVF failures and in poor responders. This protocol combines the effect of the microdose flare on endogenous follicle stimulating hormone (FSH) release with the benefit of an immediate luteinizing hormone suppression of the GnRH antagonist. The basic hypothesis of this approach can also benefit IVF patients with good prognosis without compromising the ability to use gonadotrophin-releasing hormone (GnRH) agonist to effectively trigger ovulation, while completely eliminating any threat of clinically significant ovarian hyperstimulation syndrome (OHSS). The purpose of the study is to compare cycles consisting of ultrashort flare GnRH agonist combined with flexible multidose GnRH antagonist with those using the flexible multidose GnRH antagonist protocol 1\. To compare the IVF outcome variables and ongoing pregnancy rates.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
200
In vitro fertilization (IVF/ICSI)
In vitro fertilization (IVF/ICSI)
Sheba Medical Center- IVF unit
Ramat Gan, Israel, Israel
Ongoing pregnancy rates
Time frame: 2 years
Total gonadotropin use
Time frame: 2 Years
Biochemical pregnancy
Positive pregnancy test without documentation of intrauterine or extrauterine pregnancy
Time frame: 2 Years
Clinical pregnancy
Positive pregnancy test with documentation of intrauterine or extrauterine pregnancy
Time frame: 2 Years
Multiple pregnancy rate
Time frame: 2 Years
Miscarriage rate
Time frame: 2 Years
Fertilization rate
Time frame: 2 Years
Number of oocytes
Time frame: 2 years
OHSS rates
Time frame: 2 Years
Embryo quality
Grading of a day 3 embryo based on the number of cells that make up the embryo, the amount of fragmentation, and the symmetry of each of the embryo's cells (blastomeres). E.g. good quality embryos: embryos that reach the eight-cell stage with less than 20% fragmentation on day 3
Time frame: 2 Years
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