title: [Comparison of a long-acting and short-acting GnRH analog in combination with gonadotropins in in vitro fertilization under various indications].
abstract: The occurrence of a premature luteinizing hormone (LH)-surge during gonadotropin stimulation for in-vitro fertilization leads to cancellation of the cycle. Moreover, insufficient follicular maturation is often caused by elevated basal gonadotropin levels. Therefore the gonadotropin releasing hormone (GnRH) agonist, D-TRP6-LHRH, was applied to patients exhibiting premature LH-surges, hyperandrogenemia or incipient premature menopause. 119 cycles were treated, using a long-acting versus a short-acting GnRH agonistic analogue. In protocol 1, patients received daily subcutaneous injections of 100-500 micrograms of a short-acting compound. In protocol 2, a long-acting bolus of 3.2 mg was given intramuscularly. Concomitant human gonadotropin (HMG) stimulation started in protocol 1 after clinical and biochemical evidence of pituitary suppression and in protocol 2 after a fixed suppression interval of 14 days. In protocol 1 higher estrogen levels were reached with more oocytes harvested. The pregnancy rate per transfer was increased from 3.5% to 18%, with most pregnancies occurring with protocol 2. The cancellation rate of 13.4% was mainly due to insufficient follicular development in patients, in whom premature menopause was suspected. Hyper-androgenemic patients with an elevated LH/FSH-ratio exhibited the best follicular recruitment with the highest pregnancy rate of 25% per transfer. Thus combined GnRH-agonist/gonadotropin stimulation offers a causal treatment for patients susceptible to premature LH-surges and for hyperandrogenemic patients.
authors.affiliation: Universitäts-Frauenklinik Bonn.
authors.forename: R K
authors.initials: RK
authors.lastname: Schmutzler
authors.forename: C
authors.initials: C
authors.lastname: Reichert
authors.forename: K
authors.initials: K
authors.lastname: Diedrich
authors.forename: L
authors.initials: L
authors.lastname: Wildt
authors.forename: C
authors.initials: C
authors.lastname: Diedrich
authors.forename: H
authors.initials: H
authors.lastname: van der Ven
authors.forename: S
authors.initials: S
authors.lastname: Al-Hasani
authors.forename: D
authors.initials: D
authors.lastname: Krebs
mesh_terms: D000328:Adult; D002986:Clinical Trials as Topic; D003131:Combined Modality Therapy; D003692:Delayed-Action Preparations; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods*; D005640:Follicle Stimulating Hormone / Q000097:blood; D007987:Gonadotropin-Releasing Hormone / Q000008:administration & dosage / Q000031:analogs & derivatives*; D006801:Humans; D007247:Infertility, Female / Q000097:blood / Q000209:etiology / Q000628:therapy*; D007273:Injections, Intramuscular; D007986:Luteinizing Hormone / Q000097:blood; D011247:Pregnancy; D017329:Triptorelin Pamoate
chemical_list: D003692:Delayed-Action Preparations; D017329:Triptorelin Pamoate; D007987:Gonadotropin-Releasing Hormone; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone
vernacular_title: Vergleich eines langwirksamen und kurzwirksamen GnRH-Analogs in Kombination mit Gonadotropinen zur In-vitro-Fertilisierung unter verschiedenen Indikationsstellungen.