Alternate day and daily administration of GnRH antagonist may prevent premature luteinization to a similar extent during FSH treatment

Abstract

Whether alternate day is as effective as daily administration of ganirelix in preventing premature luteinization should be addressed in a non-inferiority trial powered to evaluate live birth rate.

Is a premature rise in luteinizing hormone in the absence of increased progesterone levels detrimental to pregnancy outcome in GnRH antagonist in vitro fertilization cycles

“…In our patient population, the incidence of premature LH rise in first GnRH-antagonist IVF-ICSI cycles was 8%, almost sixfold higher than the incidence of 1.4% reported in the ganirelix dose-finding study at the 0.25 mg daily dose, which is currently used in practice (10). One possible reason for this finding is that most of the published literature to date on outcomes with GnRH-antagonist cycles comes from randomized, controlled trials, where a homogeneous patient population is selected, and older patients, patients with ovulatory dysfunction, and patients who are overweight are routinely excluded (1,4,6,7,15). Our data provide unique insight into a more generalized application of GnRH-antagonist protocols to a heterogeneous infertility population, suggesting that a premature LH rise is more frequent than originally anticipated.…”

Initiation of GnRH antagonist on Day 1 of stimulation as compared to the long agonist protocol in PCOS patients. A randomized controlled trial: effect on hormonal levels and follicular development

“…Alternatively, the degree of suppression with GnRH antagonist might not be adequate to maintain LH levels suppressed to a similar extent as the GnRH agonist group. The adequacy of LH suppression using the standard dose of 0.25 mg daily has been put in doubt recently (Messinis et al, 2005).…”

Does premature luteinization or early surge of LH impair cycle outcome? Report of two successful outcomes

“…Likewise, in stimulated intrauterine cycles, none of the 17 subjects with both an LH level >10 IU/L and a progesterone level >1.0 ng/mL became pregnant [4]. Among the 73 patients undergoing IVF stimulated with recombinant FSH, none of the seven patients with progesterone values >4 ng/mL became pregnant; however, five women with LH rises >10 IU/L without accompanying increase in progesterone became pregnant [18]. In donor oocyte cycles, where endometrium is spared from the negative effects of high progesterone, premature luteinization did not have a negative impact on oocyte and embryo quality [9].…”