ENHANCEMENT OF OVARIAN RESPONSIVENESS WITH MICRODOSES OF GONADOTROPIN-RELEASING-HORMONE AGONIST DURING OVULATION INDUCTION FOR IN-VITRO FERTILIZATION

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.