Comparison of Assisted Reproductive Technology Cycle Outcomes Among Daily Buserelin, Daily, and Every Other Day Triptorelin in Infertile Patients Referring to Imam Khomeini Hospital Complex: A Randomized Controlled Trial

Nowadays, infertility has been brought up as one worldwide reproductive health problem (1). In the United States, estimation from a large national sample shows that 10%-15% of American women aged 15-44 years, who are non-surgically sterile, suffered from current infertility (2). In Iran, as a developing country, the overall infertility prevalence was estimated at 8% with a 95% confidence interval of 3.2-15.0 (3). In vitro fertilization (IVF) is one of the most commonly accepted treatments for unexplained infertility (4,5). According to some studies (6-8), gonadotropin-releasing hormone (GnRH) agonists have widely been used as an appendant for ovarian stimulation protocols revolving around assisted reproductive technologies (ARTs). Several protocols have been introduced in the literature, including long, short, and ultra-short protocols (9). Triptorelin, along with buserelin has been introduced as an effective prevailing treatment in this setting. Several RCTs have compared different agonists (10-14). However, the appropriate dose finding for infertility treatment has remained a critical issue. Triptorelin is one of the most commonly used GnRH analogues in Iran. Janssens et al demonstrated that even 15 μg triptorelin can prevent premature luteinizing hormone (LH) surge (15). Although low doses at 15 μg were effective, the present study intended to evaluate the effect of every other day administration of higher doses at 100 μg. The effectiveness of every other day triptorelin 0.1 mg in ART cycles compared with other protocols is unclear enough and remains unproven. Therefore, the goal of the current randomized trial was to compare the effectiveness of every other day triptorelin 0.1 mg in comparison with two other protocols (i.e., daily buserelin and daily triptorelin 0.1 mg in ART Abstract Objectives: Different types of gonadotropin-releasing hormone (GnRH) agonist protocols are used in assisted reproductive technology (ART) cycles although the role of every other day GnRH agonist administration is not well understood. Thus, this study compared the effectiveness of different ways of the administration of GnRH agonists in the ovarian stimulation long protocol and their effects on in vitro fertilization (IVF) outcomes. Materials and Methods: In a randomized controlled trial (RCT), 138 patients were randomly assigned to 3 groups with 46 patients. In group A, patients were treated with daily buserelin 0.5 mg subcutaneously and those in group B were treated with triptorelin 0.1 mg daily, and finally, patients in group C received triptorelin 0.1 mg every other day (all under a long protocol). Eventually, controlled ovarian stimulation was performed with the follicle-stimulating hormone (FSH). Results: There was no significant difference in biochemical and clinical pregnancy, along with abortion and twin rates between the comparison groups. Meanwhile, the number of gonadotropin injections was significantly lower in group C (P = 0.033). Moreover, the number of follicles and days of ovarian stimulation did not have a significant difference between study groups. Finally, the number of metaphase 2 oocytes and embryos was significantly higher in group A (P = 0.001). Conclusions: In general, pregnancy and abortion rates did not significantly differ between the comparison groups and, the number of gonadotropin injections was significantly lower in the triptorelin 0.1 mg every other day group. Thus, our finding revealed that every other day use of triptorelin 0.1 mg, comparing its daily use or daily buserelin, might be cost-benefit.