COMPARISON OF LEUPROLIDE ACETATE AND HUMAN CHORIONIC-GONADOTROPIN FORTHE INDUCTION OF OVULATION IN CLOMIPHENE CITRATE-STIMULATED CYCLES

Objective: To examine the relative efficacies of leuprolide acetate (L A) and hCG in inducing ovulation and a normal luteal phase during clom iphene citrate (CC)-stimulated superovulation cycles. Design: Prospect ive, randomized, blinded, and cross-controlled in consecutive cycles. Setting: Large military tertiary care center. Patients: Twenty-one ovu latory patients undergoing superovulation with CC and IUIs for the tre atment of unexplained or male factor infertility. Interventions: Clomi phene citrate (100 mg/d) on cycle days 5 through 9 in both of the stud y cycles. Administration of 2 mg SC LA in one cycle and 10,000 IU IM h CG in another cycle for induction of the midcycle surge. Main Outcome Measures: Serum LH, FSH, E(2), and P levels every 12 hours for 36 hour s after administration of either LA or hCG to characterize the midcycl e hormonal dynamics. Luteal phase duration and serum P levels during t he midluteal phase were used to estimate the adequacy of the luteal ph ase. Serial ultrasounds also were done to determine the incidence of l uteinized unruptured follicle syndrome. Results: Serum FSH levels in t he periovulatory interval were significantly higher after the administ ration of LA. There were no differences in the periovulatory E(2) or P levels or the incidence of sonographic evidence of ovulation after ad ministration of either LA or hCG. Although midluteal serum P levels we re higher in the cycles in which hCG was administered, all 42 treatmen t cycles had adequate luteal phases as assessed by luteal phase durati on and three midluteal P levels. Ongoing pregnancies occurred after bo th LA- and hCG-stimulated cycles. Conclusion: Leuprolide acetate and h CG were equivalent in their abilities to induce ovulation. Further eva luation of the adequacy of the luteal phase and the ensuing pregnancy rates after LA induction of an endogenous gonadotropin surge are indic ated.