A prospective randomized comparison of luteal phase versus concurrent follicular phase initiation of gonadotropin-releasing hormone agonist for in vitro fertilization.
OBJECTIVE
To compare the effects of gonadotropin-releasing hormone agonist (GnRH-a) initiation either preceding or concurrent with controlled ovarian hyperstimulation (COH) in patients undergoing in vitro fertilization-embryo transfer (IVF-ET).


METHODS
Fifty-five patients were prospectively randomized to receive either GnRH-a on cycle day 21 before COH until ovarian suppression was achieved (group I) or GnRH-a concurrently with COH commencing on cycle day 3 (group II).


METHODS
Serum gonadotropin and ovarian steroid hormone levels, as well as fertilization, spontaneous abortion, and live birth rates.


RESULTS
Twenty-six patients in group I and 29 patients in group II underwent COH for IVF-ET. Patients in group II had significantly higher serum luteinizing hormone, progesterone, and testosterone levels during stimulation with human menopausal gonadotropins (hMG) before oocyte retrieval (P < 0.05). Despite similar fertilization, biochemical, and clinical pregnancy rates, the spontaneous abortion rate was higher in group II (5/6) compared with group I (1/7) (P < 0.05). Thus, the live birth rate/retrieval for group I was 6 of 24 (25%) as compared with that of group II, which was 1 of 26 (3.8%) (P < 0.05).


CONCLUSIONS
The initiation of GnRH-a in the follicular phase concurrently with hMG is associated with evidence of premature luteinization, hyperandrogenemia, and poorer pregnancy outcome compared with luteal phase administration of GnRH-a before hMG for IVF-ET.
San Roman
G A
GA
Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California 90048.
Surrey
E S
ES
Judd
H L
HL
Kerin
J F
JF
D000328:Adult; D000728:Androgens / Q000097:blood; D004624:Embryo Transfer; D004958:Estradiol / Q000097:blood; D005260:Female; D005307:Fertilization in Vitro; D005640:Follicle Stimulating Hormone / Q000097:blood; D005498:Follicular Phase / Q000187:drug effects*; D006801:Humans; D016729:Leuprolide / Q000494:pharmacology*; D008183:Luteal Phase / Q000187:drug effects*; D007986:Luteinizing Hormone / Q000097:blood; D009865:Oocytes; D010062:Ovulation Induction; D011247:Pregnancy / Q000706:statistics & numerical data; D011374:Progesterone / Q000097:blood; D011446:Prospective Studies
D000728:Androgens; D011374:Progesterone; D004958:Estradiol; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone; D016729:Leuprolide