Procrin

Ovarian stimulation was initiated on day 2 of the menstrual cycle with 225 IU/day of recombinant FSH (rFSH) (Puregon^®; Merck and Co, Inc., Whitehouse Station, NJ, USA) for 5 days. The dose of rFSH was adjusted for each patient according to the follicular growth detected by ultrasonography after the 5th day of rFSH administration. A GnRH antagonist (ganirelix; Orgalutran^®; Merck and Co, Inc.) at a dose of 0.25 mg/dL per day was administered from day 6 of rFSH onwards to prevent LH surge. When at least three follicles at least 17 mm in diameter were observed by ultrasonography, a GnRH agonist (Procrin^®; Abbott Laboratories, Abbott Park, IL, USA) at a dose of 0.2 mL/IU was given as a trigger. Oocytes were retrieved transvaginally 36 hours later and fertilized either by conventional in vitro fertilization (IVF) or by means of intracytoplasmic sperm injection (ICSI).

In protocols B and C, ganirelix treatment was initiated on day 10 (protocol B, midfollicular phase) or on day 20 (protocol C, early luteal phase) of the menstrual cycle at a dose of 0.25 mg/dL per day. Ganirelix treatment was given until serum estradiol levels were below 60 pg/dL. Then, the standard protocol was started with 225 IU/day of rFSH (Puregon^®; Merck and Co, Inc.). As in protocol A, the dose of rFSH was adjusted depending on the individual ovarian response after the 5th day of treatment. A fixed dose of ganirelix, 0.25 mg/dL per day, was administered from day 6 of rFSH treatment onwards to prevent premature LH surges. When at least three follicles had reached at least 17 mm in diameter, 0.2 mL/IU of the GnRH agonist Procrin^® (Abbott Laboratories) was administered to induce ovulation. Oocytes were retrieved transvaginally 36 hours later and fertilized either by conventional IVF or ICSI. The details of protocols B and C are shown in Figure 1.