Clinical information from the subject’s electronic medical record was abstracted by the research nurses. All subjects underwent an evaluation for infertility which included a follicle-stimulating hormone (FSH) level drawn on the third day of the menstrual cycle to assess ovarian reserve. After completion of the standard infertility work-up, each subject was given an infertility diagnosis by their reproductive endocrinologist according to the Society for Assisted Reproductive Technology (SART) definitions. SART diagnoses consisted of male factor infertility which included poor semen quantity/quality; female factor infertility which included endometriosis, diminished ovarian reserve, tubal and uterine disorders; other causes and unexplained infertility.
Upon completion of the infertility evaluation, subjects underwent one of three IVF treatment protocols used at the MGH Fertility Center. The three IVF treatment protocols were: (1) Luteal phase GnRH-agonist protocol using low, regular and high-dose leuprolide (Lupron), in which pituitary desensitization was begun in the luteal phase; (2) Follicular phase GnRH-agonist/Flare protocol, in which Lupron was begun in the follicular phase on day 2 of menses at 20 units and decreased to the standard dose of five units on day 5; and (3) GnRH-antagonist protocol, in which GnRH-antagonist was begun when the lead follicle reached 14 mm in size. All cycles were preceded by a cycle of oral contraceptive pills unless contraindicated. On day 3 of induced menses, exogenous gonadotropins [FSH (Gonal-F, Follistim, Bravelle)] and/or Human Menopausal Gonadotropin [hMG (Repronex, Menopur)] were initiated. In the luteal phase GnRH-agonist protocol, Lupron dose was reduced at, or shortly after, the start of ovarian stimulation with FSH/hMG. FSH/hMG and GnRH-agonist or GnRH-antagonist was continued to the day of trigger with Human Chorionic Gonadotropin (hCG), 36 h before oocyte retrieval.
Upon completion of the infertility evaluation, subjects underwent one of three IVF treatment protocols used at the MGH Fertility Center. The three IVF treatment protocols were: (1) Luteal phase GnRH-agonist protocol using low, regular and high-dose leuprolide (Lupron), in which pituitary desensitization was begun in the luteal phase; (2) Follicular phase GnRH-agonist/Flare protocol, in which Lupron was begun in the follicular phase on day 2 of menses at 20 units and decreased to the standard dose of five units on day 5; and (3) GnRH-antagonist protocol, in which GnRH-antagonist was begun when the lead follicle reached 14 mm in size. All cycles were preceded by a cycle of oral contraceptive pills unless contraindicated. On day 3 of induced menses, exogenous gonadotropins [FSH (Gonal-F, Follistim, Bravelle)] and/or Human Menopausal Gonadotropin [hMG (Repronex, Menopur)] were initiated. In the luteal phase GnRH-agonist protocol, Lupron dose was reduced at, or shortly after, the start of ovarian stimulation with FSH/hMG. FSH/hMG and GnRH-agonist or GnRH-antagonist was continued to the day of trigger with Human Chorionic Gonadotropin (hCG), 36 h before oocyte retrieval.
