Simplification of IVF: minimal monitoring and the use of subcutaneous highly purified FSH administration for ovulation induction

During the past few years much effort has been put into simplifyingthe clinical management of in-vitro fertilization/embryo transfercycles. One important step was the introduction of transvaginalultrasound-guided oocyte collection, as previously described.This study describes further simplifications of the clinicalmanagement of ovarian stimulation. During the period 1st January1991 to 31st August 1993, three major simplification steps wereintroduced. All cycles were down-regulated with a gonadotrophin-releasinghormone (GnRH) agonist according to along protocol permittingfairly precise programming of the oocyte collection. Duringperiod I (n = 329 cycles), closer monitoring by several pelvicultrasound scans and serum oestradiol was used for monitoringthe ovarian stimulation. During period II (n = 230 cycles),only one ultrasound scan was used for monitoring the ovariancycle; oocyte collections during weekends were avoided. Duringperiod III (n = 386 cycles), further simplification of the clinicalmanagement was introduced by using a highly purified folliclestimulating hormone (FSH) (Fertinorm/Metrodin HP), which wasself-administered s.c. for ovarian stimulation. The take-homebaby rates per started cycle for periods I, II and III were16.4, 32.6 and 31.3% respectively. These figures indicate thatwhen using long down-regulation with a GnRH agonist, simplificationof the monitoring of the ovarian stimulation is possible withoutdecreasing the pregnancy rate. Furthermore, the use of a highlypurified FSH, self-administered s.c., greatly simplified treatmentwithout compromising cycle outcome or increasing the risk ofdeveloping an ovarian hyperstimulation syndrome.