LHRH agonists in IVF: different methods of utilization and comparison with previous ovulation stimulation treatments

Abstract

LHRH agonists are being increasingly used in ovulation stimulation protocols in IVF programmes. We have compared the results of two methods of utilization of LHRH agonists. In the long protocol, gonadotrophin stimulation was only commenced after a preliminary period of pituitary desensitization with LHRH agonist. In the short protocol, exogenous gonadotrophins were administered shortly after the start of LHRH agonist therapy, benefiting from the gonadotrophin flare-up effect. One-hundred-and-eighty-six patients were divided equally between the two treatments. There was no difference in the ovarian response on the day of HCG or the number of mature oocytes recovered. The cleavage rate of mature oocytes was higher in the short protocol (70, versus 56, P less than 0.01). The ongoing pregnancy rate per treatment cycle was similar in both groups (18, in the long protocol and 16, in the short protocol). Analysis of the luteal phases revealed a trend for higher progesterone values in the long protocol although this was only significant on the second day following oocyte retrieval. As the clinical results were similar other factors should be taken into account when deciding therapy. These include patient convenience, cost and side-effects. Other schedules of ovulation stimulation using LHRH agonists are discussed.

RESULTS OF INSEMINATION (AIH) FOLLOWING GnRH TREATMENT OF ENDOMETRIOSIS

“…In the ®rst month of the induction treatment 5±8 (6.8 average) ova reached the 20 mm size. This number is signi®cantly di erent from the numbers of mature follicles (3.9 and 4.2), obtained after long-term therapy with GnRH analog and hMG by Schmutzler et al [12] and Leyendecker et al [10], and slightly lower than the results of Frydman et al [5] who obtained in average 8.4 ova after the long-term protocol. Hyperstimulation wasn't ob-served during the study, so lutenization was performed in each case.…”

“…After homolog arti®cial therapy 15 (45%) patients became pregnant, and 3 of these pregnancies resulted in twins. This means a 25 and 27% e ciency rate following embryo-transfe r obtained by Leyendecker et al [10] and Frydman et al [5]. The 45% success rate is probably due mostly to the young age of the patients, the rebound e ect following inhibition, and the fact that no other causes of infertility apart from endometriosis were observed.…”

Outcome of Ovarian Response after Suppression with a Gonadotropin Releasing Hormone Agonist in Different Chronological Periods prior to Gonadotropin Stimulation for in vitro Fertilization

“…The major improvement attributed to analog use is the suppression of the endogenous LH surge in cycles, where pituitary suppression preceded ovarian stimulation [6,[11][12][13], It is well known that pituitary desensitization by buserelin does not occur in all cycles within 15 days [14]. This fact was used in our study to commence HMG administration only when definite desensitization was achieved.…”

“…The GnRH-a are currently used as a standard protocol in many IVF programs. However there are different protocols for GnRH-a; the two main protocols now used in the combined treatment of GnRH-a and human menopausal gonadotropin (HMG) are the 'short' and 'long' protocols [6].…”

A prospective randomised study comparing a GnRH-antagonist versus a GnRH-agonist short protocol for ovarian stimulation in patients referred for IVF

“…Different studies (Frydman et al, 1988a(Frydman et al, , 1988bHo et al, 2008) showed no difference in delivery rate between short and long GnRH agonist protocols.…”