Objective: To compare the effect of initiating GnRH antagonist (GnRH-a) on cycle day (CD) 2 vs. CD 6 on LH, E2, and P levels in the mid and late follicular phases. Design: Nested study within a multicenter randomized controlled trial. Setting: Reproductive medicine center in an university hospital. Patient(s): One hundred sixty patients undergoing IVF/intracytoplasmic sperm injection (ICSI). Intervention(s): Recombinant FSH (150-225 IU) was administered daily from CD 2 onward. The study group (CD 2) started GnRH-a cotreatment on CD 2, whereas the control group (CD 6) started on CD 6. Main Outcome Measure(s): The follicular phase endocrine profile. Result(s): The LH levels on CD 6 were lower in the CD 2 group (0.6 ± 0.4 vs. 1.9 ± 1.4 IU/L). The CD 2 group demonstrated both lower E2levels on CD 6 (520.1 ± 429.6 pmol/L vs. 1,071.7 ± 654.2 pmol/L) and on the day of hCG administration (3,341.4 ± 1,535.3 pmol/L vs. 4,573.2 ± 2,445.4 pmol/L). The P levels did not differ on CD 6 or on the day of hCG administration. Conclusion(s): Early initiation of GnRH-a cotreatment results in a more stable endocrine profile, with more physiological levels of E2and LH during the follicular phase. The effect on clinical outcomes must be established in larger trials. Clinical Trial Registration Number: NCT00866034.

GnRH antagonist, IVF, LH, estradiol, progesterone
dx.doi.org/10.1016/j.fertnstert.2013.05.031, hdl.handle.net/1765/41069
Fertility and Sterility
Erasmus MC: University Medical Center Rotterdam

Hamdine, O, Broekmans, F.J.M, Eijkemans, M.J.C, Lambalk, C.B, Fauser, B.C.J.M, Laven, J.S.E, & Macklon, N.S. (2013). Early initiation of gonadotropin-releasing hormone antagonist treatment results in a more stable endocrine milieu during the mid and late follicular phases: a randomized controlled trial comparing gonadotropin-releasing hormone antagonist initiation on cycle day 2 or 6. Fertility and Sterility, 100(3), 867–874. doi:10.1016/j.fertnstert.2013.05.031