Cetrorelix protocol versus gonadotropin-releasing hormone analog suppression long protocol for superovulation in intracyloplasmic sperm injection patients older than 40

Objective: To determine which protocols work better between cetrorelix and long protocols in older patients in a randomized controlled study. Design: A controlled randomized study in a single private IVF center. Setting: Infertile women referred to a private IVF center. Patient(s): Five hundred sixty-four women 40 years or older undergoing IVF. Intervention(S): At their first IVF cycle, the women were randomized into two study groups using a computer-generated number sequence: 281 cases were treated with the cetrorelix protocol, and 283 patients were treated with a long protocol for controlled ovarian hyperstimulation. Main Outcome Measure(s): Days of stimulation, E-2 on the day of hCG administration, amount of FSH administered, number of oocytes yielded, number of embryos obtained, pregnancy rate, and implantation rate. Result(s): Patients treated with the long protocol showed a significantly higher number of oocytes retrieved and a higher pregnancy rate for both the cycle and transfer with respect to the cetrorelix protocol patients. The other parameter evaluated did not show any statistically significant differences. Conclusion(s): Our study showed that the long protocol performed better in older women than the cetrorelix protocol and that the GnRH antagonist may be detrimental in older women. (Fertil Steril(R) 2009;91:1842-7. (C) 2009 by American Society for Reproductive Medicine.)