title: Combined GnRH-agonist/gonadotrophin stimulation for in-vitro fertilization.
abstract: The occurrence of a premature luteinizing hormone (LH) surge during gonadotrophin stimulation for in-vitro fertilization leads to cancellation of the cycle. Moreover, insufficient follicular maturation is often caused by elevated basal gonadotrophin levels. Therefore, the gonadotrophin-releasing hormone (GnRH) agonist, D-Trp-6-LHRH, was applied to patients exhibiting premature LH surges, hyperandrogenaemia or incipient premature menopause. A total of 119 cycles were treated using a long-acting versus a short-acting GnRH agonistic analogue. In protocol 1, patients received daily s.c. injections of 100-500 micrograms of a short-acting compound. In protocol 2, a long-acting bolus of 3.2 mg was given i.m. Concomitant human gonadotrophin stimulation was 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 oestrogen 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 1. The cancellation rate of 13.4% was mainly due to insufficient follicular development in patients in whom premature menopause was suspected. Hyperandrogenaemic 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/gonadotrophin stimulation offers a causal treatment for patients susceptible to premature LH surges and for hyperandrogenaemic patients.
authors.affiliation: Department of Obstetrics and Gynaecology, University of Bonn, FRG.
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: S
authors.initials: S
authors.lastname: Al-Hasani
authors.forename: H
authors.initials: H
authors.lastname: van der Ven
authors.forename: D
authors.initials: D
authors.lastname: Krebs
mesh_terms: D000328:Adult; D002986:Clinical Trials as Topic; D002996:Clomiphene / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D005307:Fertilization in Vitro; D005640:Follicle Stimulating Hormone / Q000097:blood / Q000378:metabolism; D007987:Gonadotropin-Releasing Hormone / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D007986:Luteinizing Hormone / Q000097:blood / Q000378:metabolism; D008186:Luteolytic Agents / Q000627:therapeutic use; D008596:Menotropins / Q000627:therapeutic use*; D011247:Pregnancy; D017329:Triptorelin Pamoate
chemical_list: D008186:Luteolytic Agents; D017329:Triptorelin Pamoate; D002996:Clomiphene; D007987:Gonadotropin-Releasing Hormone; D008596:Menotropins; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone