SIGNIFICANCE OF AN ABNORMAL RESPONSE DURING PITUITARY DESENSITIZATIONIN AN IN-VITRO FERTILIZATION AND EMBRYO-TRANSFER PROGRAM

Purpose: Our purpose was to evaluate the NF-ET outcome in patients who did not achieve timely pituitary-ovarian suppression following ''long ''-protocol GnRH agonist (GnRH-a) administration. Methods: A retrospec tive analysis was done on 96 IVF treatment cycles characterized by a d elayed response (DR) to long-protocol GnRH-a treatment. The study incl uded those patients who either achieved ovarian suppression (E(2) less than or equal to IIO pM) despite an elevated LH level (group DR-A) or had pituitary desensitization (LH less than or equal to 1.5 IU/L) wit hout ovarian suppression (group DR-B) on day 12 of GnRH-a treatment bu t needed an extended course of GnRH-a treatment to achieve complete su ppression. These patients had gonadotropin stimulation either from day 12, despite an elevated level of LH (subgroup DR-A1; n = 13) or eleva ted E(2) levels (subgroup DR-B1; n = 9), or after achieving a complete hypogonadotropic-hypopgonadal stare following an extended course of G nRH-a treatment [subgroups DR-iia (n 46) and DR-B2 (n = 28)]. The outc ome was compared with that of 88 cycles of normal responders (group NR ) who had pituitary-ovarian suppression by day 12 of GnRH-a administra tion. Results: Ovarian response and pregnancy rates in subgroups DR-A1 and DR-A2 were statistically not different and comparable to those in tile NR group. In subgroups DR-B1 and DR-B2, E(2) response and rates of oocyte retrieval and pregnancy were significantly lower than those in the other groups, but fertilization and cleavage rates were similar : The requirement of gonadotropin for ovarian stimulation was comparat ively higher in subgroup DR-A2 and both DR-B subgroups. Conclusions: T here aas no treatment cancellation in group NR and both DR-A subgroups , but 22% of the cycles in DR-B1 and 14% of the cycles in DR-B2 were c anceled due to poor ovarian response. It therefore appears that during long-protocol pituitary desensitization the post-GnRH-a level of seru m E(2), rather than LH, better predicts IVF-ET outcome.