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Although nowadays most oocyte retrievals for in-vitro fertilization (IVF) are performed using a transvaginal, ultrasound-directed technique, monitoring of follicular development is still often performed via the abdominal route. On the bases of 106 sonographies carried out on 71 patients during ovulation monitoring within an IVF programme, we demonstrated that the number of follicles visualized endovaginally was significantly higher than that visualized by the abdominal route: n = 1124 versus n = 772 respectively, and that their size was significantly greater using the transvaginal approach: 20.8 mm versus 18.8 mm respectively, for the largest follicle. Consequently, if ovulation monitoring is carried out transvaginally, the follicular size criteria on which human chorionic gonadotrophin is administered must be reconsidered.

It has previously been demonstrated that use of gonadotrophin releasing hormone analogues allows the administration of HCG to be delayed and makes it possible to avoid oocyte retrievals at weekends. In this study, we demonstrate that it is also possible to avoid embryo transfers on Sundays, by delaying transfers of Friday retrievals until Monday, without any apparent change in the results. This facility should improve the cost-effectiveness of assisted reproduction programmes.

In earlier IVF programmes, subcutaneous buserelin (Suprefact, Hoechst) was initially administered three times per day (200 micrograms x 3); then twice daily (300 micrograms x 2). We now suggest that a single administration of 600 micrograms daily may be equally effective. In a preliminary study, 20 patients were selected on the basis of tubal or idiopathic infertility and received 0.6 ml buserelin subcutaneously once a day, beginning on day 1 or 2 of the cycle. A sufficient pituitary desensitization was obtained on day 10 in 75% of patients and on day 16 for 100% and the ongoing pregnancy rate was 35% per treatment cycle. A randomized study comparing the effect of 600 micrograms of buserelin administered in one (n = 50) or two injections (n = 46), has been carried out and indicates that the results in terms of the ovarian suppression and pregnancy rates, were similar. Therefore, this protocol represents a simplification of the treatment with buserelin.