Menogon

Hormonal stimulation was performed in GnRH-antagonist protocols with recombinant FSH (Puregon, MSD; Gonal F, MerckSerono) or HMG (Human Menopausal Gonadotropin) (Menogon or Menopur, Ferring). The starting dosage was chosen according to the results of the Anti-Mullerian-Hormone (AMH) as well as the antral follicle count (AFC) [20 (link)]. Starting on day 5, patients received a daily dosage of 0.25 mg GnRH-antagonist (Orgalutran, MSD or Cetrotide, MERCK) to prevent early ovulation.
During the stimulation course, stimulation dosage was adapted to the individual patient`s response. GnRH-agonist trigger for final oocyte maturation was used to avoid ovarian hyperstimulation syndrome as the ultrasound showed > 13 follicles with a size of ≥ 11 mm, which was described previously as a risk factor for OHSS-development [21 (link)]. Patients received 0.3 mg of GnRH-agonist (Decapeptyl, Ferring) for final oocyte maturation, when > 3 follicles were ≥ 17mm in diameter. OPU was performed 36 h later under general anesthesia, aspirating all follicles of a size of ≥11 mm.

In this study, suppression protocol was used. On the second day of the last menstrual period, when no ovarian cyst was observed in a transvaginal ultrasound scan, ovarian stimulation was commenced with Gonal-F (Serono, Switzerland) in combination with Menogon (Ferring, Germany). Serial ultrasound scans were carried out and when the dominant follicle reached the size of 13-14 mm, gonadotropin-releasing hormone (GnRH) antagonist was administered daily. Ovulation was triggered with 10,000 IU hCG, when the size of dominant follicles reached 17-18 mm. After 36 hours, transvaginal oocyte retrieval was carried out.

All patients had previously had fresh cycles (IVF/ICSI) regardless of the freeze-thaw interval. Controlled ovarian stimulation (COS) in fresh cycles was performed with the aid of rFSH (Gonal-f, Merck, NJ, USA) or human menopausal gonadotropin (HMG) (Menogon, Ferring, Saint-Prex, Switzerland). In the long protocol, a gonadotropin- releasing hormone (GnRH) agonist was started on day 21 of the previous menstrual cycle (Decapeptyl 0.1 mg/day, IPSEN, Paris, France); in the short protocol, Decapeptyl 0.05mg/ day was started on day 1 of the stimulation. Another alternative was the fixed GnRH antagonist protocol (Cetrotide 0.25 mg/day, Merck, NJ, USA), started on day 6 of stimulation. The cycles were monitored through serial vaginal ultrasound scans and serum levels of estradiol (E2) and FSH. Whenever needed, the rFSH/hMG dosages were adjusted based on ovarian response. When two or more dominant follicles reached a mean diameter ≥ 18 mm or three or more reached a mean diameter of ≥ 17 mm, the patients were administered 5-10,000 IU hCG. The oocytes were retrieved 36 hours after hCG injection (Pregnyl, Merck, NJ, USA).