Orgalutran

Both the standard GnRH agonist and antagonist protocol were used for controlled ovarian stimulation. Briefly, the long GnRH agonist protocol was based on the administration of daily leuprorelin (Enantone die; Takeda) or triptorelin (Fertipeptil; Ferring) in the mid-luteal phase before the stimulation cycle. The administration of recombinant FSH (rFSH; GonalF [Merck Serono] or Puregon [MSD]), hMG (Meropur, Ferring), or urinary FSH (Fostimon; IBSA) was started when pituitary desensitization was achieved ($14 days after the initiation of GnRH agonists), as evidenced by the absence of ovarian follicles >10 mm and endometrial thickness <4 mm on transvaginal ultrasound examination. In the GnRH antagonist protocol (Cetrotide [Merck Serono] or Orgalutran [MSD]) treatment with FSH or hMG was started on day 2-3 of the stimulation cycle, and the GnRH antagonist was added when one or more follicles had reached a diameter R14 mm. The starting dose of FSH/hMG was based on age, body weight, and ovarian reserve, ranging from 100 to 225 IU/d, per the internal protocol of the clinic. An ovarian ultrasound was performed on stimulation day 5-6, and gonadotropin doses were adjusted according to the ovarian response. When at least one follicle reached R18 mm, 10,000 IU hCG or 250 mg recombinant hCG was administrated; 34-36 hours later, follicles were aspirated under patient sedation.

Patient treatment consisted of two types of GnRH-LH suppression (Orgalutran [MSD] and Cetrotide [Merck Serono]) in conjunction with commercially prepared rFSH (Puregon [MSD] and Gonal-f [Merck Serono]), from cycle day 2 for approximately 10 days, as described by Regan et al. (34) . The dosages of rFSH were administered according to a well-described and validated algorithm designed to collect 10 AE 2 oocytes and avoid ovarian hyperstimulation syndrome (36) . Ovulation was triggered with 10,000 IU hCG (Pregnyl, MSD), and oocyte retrieval was 36 hours later by transvaginal oocyte aspiration (33) . Patients classified as poor prognosis due to poor ovarian response or with three or more failed attempts to conceive through IVF treatment with gonadotrophin alone were co-treated with a total of 60 IU GH (Saizen, Serono) over a period of 20-24 days in the lead-up to IVF. Specifically, a total of six injections of GH was administered to 10 patients on day 21 of the preceding cycle, and on days 2, 6, 8, 10, and 12 of the ensuing IVF cycle (10 IU per injection, a total of 60 IU). The women were aged R39 years and had at least one failed IVF cycle (18) .