C. Schmidtsarosi et al., OVULATION TRIGGERING IN CLOMIPHENE CITRATE-STIMULATED CYCLES - HUMAN CHORIONIC-GONADOTROPIN VERSUS A GONADOTROPIN-RELEASING-HORMONE AGONIST, Journal of assisted reproduction and genetics, 12(3), 1995, pp. 167-174
Purpose: To compare the Iue of human chorionic gonadotropin (hCG) to a
gonadotropin releasing hormone (GnRH) agonist, nafarelin, in initiati
ng ovulation and supporting the luteal phase after priming with clomip
hene. Methods: In 26 infertile women 50 mg clomiphene citrate produced
a preovulatory-size follicle. Then, 11 women were randomized to recei
ve two 400-mu g doses of nafarelin intranasally 16 h apart, and 15 wom
en were injected intramuscularly with 5000 IU of hCG (luteal day 0 = L
D0). Starting on LD6, 7 move 400-mu g doses of nafarelin were repeated
on an every 16-h schedule or a single 2500 IU dose of hCG was given,
1 espectively. Serum levels of follicle stimulating hormone (FSH), lut
einizing hormone (LH), estradiol (E(2)), progesterone (P), and hCG wer
e measured. On LD13, endometrium was evaluated with ultrasonography an
d biopsy in 19 nonpregnant women. Results: As judged by a threefold ri
se in serum LH, an LH surge was detected on LD1 in all 11 nafarelin pa
tients, but in only 8 hCG patients (P = 0.01). LH and FSH levels were
significantly higher on LD1, 7, and 8 and were significantly suppresse
d on LD13 in the nafarelin group. All patients had mid-luteal P levels
greater than 10 ng/ml and luteal phases longer than 13 days. Signific
antly different luteal E(2) or P levels were noted only on LD13, with
lower values in the nafarelin group. Pregnancies were achieved in 3 of
11 nafarelin cycles and 2 of 15 hCG cycles. Luteal phase defects were
also similar: 4 of 8 nafarelin patients and 7 of 11 hCG patients. Con
clusion: Nafarelin or hCG in conjunction with clomiphene can result in
viable pregnancies, but is associated with low pregnancy rates and a
high incidence of luteal phase defects.