INCOMPLETE ANDROGEN AND PROGESTERONE SUPPRESSION FOLLOWING MIDLUTEAL GNRHA PRIOR TO CONTROLLED OVARIAN HYPERSTIMULATION OF IVF-ET

Purpose: We aimed to determine if midluteal GnRH agonist (GnRHa) use p rior to controlled ovarian hyperstimulation (COH) results in uniform p rogesterone and androgen suppression and whether elevations of these h ormones occurring early in follicular development may adversely effect the outcome of IVF-ET. Methods: Forty-four COH cycles using midluteal GnRHa were evaluated Serum gonadotropins (LH and FSH) and gonadal ste roids (E-2, A, P-4, and T) were measured after 10 days of GnRHa admini stration [cycle day 31 (CD 31)] and again on the day of ACG administra tion, following COH. Cycle outcomes evaluated were the number of oocyt es retrieved, morphologic grade, fertilization, implantation, pregnanc y, and spontaneous abortion rates. Results: Endogenous serum FSH was u niformly suppressed (6.32 +/- 0.47 IU/L) on CD 31, however; LH was nor (23.76 +/- 0.76 IU/L). Five and four tenths percent of cycles demon d emonstrated low-level P4 elevations (greater than or equal to 0.9 ng/m l), 24.4% demonstrated serum androstenedione levels greater than or eq ual to 600 pg/ml, and 39% of cycles were characterized by serum T leve ls greater than or equal to 200 pg/ml despite evidence of E-2 suppress ion (less than or equal to 30 pg/mU and the absence of follicular grow th by sonography. LH levels were not predictive of incomplete P-4 or a ndrogen suppression. Elevations of either P-4, A, or T occurring early in the follicular phase were not found to correlate with an impairmen t in clinical cycle outcome. Conclusions: Midluteal GnRHa rue prior to COH may result in incomplete suppression of circulating progesterone and androgens. However; these relative elevations, occurring early in the development of the follicular cohort, did not appear to affect NF cycle outcome adversely.