In vitro fertilization for Orthodox Jewish couples: antagonist cycle modifications allowing for mikveh attendance before oocyte retrieval

ObjectiveTo describe a novel method of altering conventional gonadotropin-releasing hormone (GnRH) antagonist in vitro fertilization (IVF) cycles, thereby allowing for the observance of ritual Jewish practices, and to investigate the impact of these cycle modifications on IVF outcomes.DesignRetrospective cohort study.SettingAcademic medical center.Patient(s)Orthodox Jewish couples undergoing GnRH antagonist IVF cycles at The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College from January 1, 2007, to November 1, 2011, in whom cycle starts were delayed using GnRH antagonists and estradiol patches.Intervention(s)GnRH antagonist administration on cycle days 2, 3, and 4, as well as estradiol patch application on cycle days 2, 4, and 6.Main Outcome Measure(s)Days of stimulation, total cycle length, implantation, clinical pregnancy, and live-birth rate were compared for 42 Orthodox Jewish couples undergoing a “mikveh patching protocol” versus 42 control patients matched for age, diagnosis, and IVF cycle characteristics.Result(s)The protocol modifications successfully ensured the ability to visit the mikveh before retrieval by extending total cycle length by 3.85 days on average, with no decrement in implantation (43.2% vs. 39.3%), clinical pregnancy (57.1% vs. 59.5%), or live-birth rates (50.0% vs. 54.8%) as compared with controls.Conclusion(s)GnRH antagonist cycles can be successfully modified to allow for IVF that remains consistent with the observance of Orthodox Jewish practices.