Rt. Scott et D. Navot, ENHANCEMENT OF OVARIAN RESPONSIVENESS WITH MICRODOSES OF GONADOTROPIN-RELEASING-HORMONE AGONIST DURING OVULATION INDUCTION FOR IN-VITRO FERTILIZATION, Fertility and sterility, 61(5), 1994, pp. 880-885
Objective: To determine if women who previously had demonstrated poor
ovarian responsiveness during ovulation induction for IVF would obtain
an improved follicular response by the administration of microdoses o
f GnRH agonist (GnRH-a).Design: Prospective evaluation using the same
patients' previous assisted reproductive technology cycles as historic
controls. Setting: Large military tertiary care center. Patients: Thi
rty four patients who were low responders (peak E(2) < 500 pg/mL [conv
ersion factor to SI unit, 3.67]) during ovulation induction with lutea
l phase GnRH-a suppression followed by exogenous gonadotropins. Interv
entions: Follicular phase administration of 20 mu g leuprolide acetate
every 12 hours beginning on cycle day 3 and supplemented with exogeno
us gonadotropins beginning on cycle day 5. Main Outcome Measures: Pair
ed analysis of initial E(2) response, peak E(2) level attained, number
of follicles greater than or equal to 16 mm, duration of stimulation,
ampules of gonadotropins required, late follicular LH levels, number
of mature oocytes retrieved, and fertilization rates. Results: Ovarian
responsiveness was enhanced during the microdose GnRH-a stimulation c
ycle when compared with the previous stimulation cycle. Specifically,
the patients had a more rapid rise in E(2) levels, much higher peak E(
2) levels, the development of more mature follicles, and the recovery
of larger numbers of mature oocytes at the time of retrieval. None of
the patients had premature LH surges as evidenced by a significant ris
e in LH levels or a significant decline in E(2) levels. There were no
differences in the fertilization rates. Conclusion: Microdose GnRH-a a
dministration beginning in the early follicular phase may result in an
augmented ovarian response when compared with traditional GnRH-a-exog
enous gonadotropin stimulations. Additionally, it may decrease gonadot
ropin requirements while effectively preventing premature LH surges.