RISK OF REPEATED SPONTANEOUS LUTEINIZING-HORMONE SURGES IN OVARIAN STIMULATION FOR INVITRO FERTILIZATION

Although spontaneous luteinizing hormone (LH) surges are preventable w ith gonadotropin releasing hormone agonist (GnRH-a) inclusion in ovari an stimulation protocols, GnRH-a-containing protocols are more expensi ve and associated with an increased risk of ovarian hyperstimulation s yndrome. The present study assessed whether spontaneous LH surges occu r in predictable patterns, allowing GnRH-a to be utilized selectively. We assessed 1,103 patients receiving clomiphene citrate/human menopau sal gonadotropin (CC/hMG) without GnRH-a for their first in vitro fert ilization (IVF) cycle and observed spontaneous LH surges in 30.4%. Whe n patients who demonstrated a spontaneous LH surge received a second C C/hMG stimulation protocol, 45.9% surged again. Of those patients who did not demonstrate a spontaneous LH surge in their initial CC/hMG cyc le, only 23.0%, significantly less (P<.001), surged in their second cy cle. Of those patients who did not surge in their first two cycles, on ly 15.7% had an LH surge in their third cycle (P<.001). Thus' if all p atients received CC/hMG without GnRH-a as their first IVF stimulation protocol, GnRH-a could be reserved for patients who have demonstrated a spontaneous LH surge. By tailoring the treatment plan, the pregnancy rate would be optimized while decreasing cycle cancellations due to s pontaneous LH surges in those patients susceptible to LH surges and li miting costs and inconvenience for patients unlikely to surge spontane ously.