Experience with a new fixed-stimulation protocol without hormone determinations for programmed oocyte retrieval for in-vitro fertilization

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Abstract
A new fixed schedule of ovarian stimulation for in-vitro fertilization (IVF) was developed that is not only simpler and easier to handle for the patients but also gives a better fertilization and pregnancy rate. The period and the start of stimulation is shifted by means of a contraceptive pill in such a way that stimulation is generally started on a Sunday. The patient takes clomiphene, (100 mg) for 5 days and prednisolone (7.5 mg) for 30 days to suppress possible exaggerated adrenal androgens, and receives 150 IU human menopausal gonadotrophln (HMG) i.m. every other day from her doctor at home. From the 8th day of stimulation onwards follicular growth is registered by daily ultrasound at the IVF centre. A dose of 5000 IU human chorionic gonadotrophin (HCG) is given when the dominant follicle exceeds 18 mm diameter. Blood sampling for hornone estimations is not necessary and only one sample of urine is needed for the luteinizing hormone (LH) estimation before HCG. In comparison to clomiphene only, clomiphene plus HMG/follicle stimulating hormone (FSH) and HMG/FSH only, this protocol resulted in a significantly higher fertilization and pregnancy rate per follicular puncture. The rate of abortions and extrauterine pregnancies, on the other hand, was decreased. When comparing repetitive IVF cycles with the first IVF cycle, a significant reduction of oocytes in repetitions was found, while there was no difference found in the number of fertilized eggs. The pregnancy rate, on the other hand, was increased in the repeat-cycles. Since the stimulation protocol was exactly the same for all cycles in this study we believe that the inverse relationship of oocytes and pregnancies seen in repeated IVF cycles is the result of a decrease in stress when patients become accustomed to the treatment. This hypothesis is underlined by the parallel finding in the male partner. His spermiogram showed a significant improvement with regard to morphology when repeated IVF treatments were compared with the first treatment. These results seem to show that stress under IVF may significantly influence the function of the gonads and thereby the outcome of IVF. The new protocol seems to be less stressful for patients, thus enabling more attempts at IVF.

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