Ovarian activity during follicular-phase down regulation in in vitro fertilization is associated with advanced maternal age and a high recurrence rate in subsequent cycles.
OBJECTIVE
Previous reports have suggested that the ovarian response to leuprolide acetate is predictive of in vitro fertilization pregnancy rates. This study evaluated the outcome of in vitro fertilization cycles complicated by elevated estradiol levels during leuprolide acetate down regulation and the outcome of subsequent cycles in the same patients.


METHODS
Two hundred fifty-two in vitro fertilization cycles were initiated utilizing leuprolide acetate down regulation beginning on cycle day 1.


RESULTS
Seventy-four of these cycles had an elevated estradiol level at the time of the baseline scan (28%). This group of patients had a higher maternal age, a higher cycle cancellation rate (27.5 vs 16.3%), and a high rate of recurrence on subsequent cycles (63%).


CONCLUSIONS
The pregnancy rate per retrieval was equivalent in the two groups. This suggests that patients with advanced maternal age or a history of failure to suppress in a previous cycle may benefit from alternate regimens of superovulation.
Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York, USA.
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Saad
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Salmansohn
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Kelly
D000328:Adult; D015536:Down-Regulation / Q000502:physiology*; D004958:Estradiol / Q000097:blood; D005260:Female; D005307:Fertilization in Vitro; D005498:Follicular Phase / Q000187:drug effects / Q000502:physiology*; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists; D006801:Humans; D016729:Leuprolide / Q000494:pharmacology; D008423:Maternal Age; D010048:Ovarian Cysts / Q000503:physiopathology; D010053:Ovary / Q000187:drug effects / Q000502:physiology*; D010062:Ovulation Induction; D011237:Predictive Value of Tests; D011247:Pregnancy; D018873:Pregnancy Rate; D011863:Radioimmunoassay; D012008:Recurrence; D013480:Superovulation / Q000502:physiology
D007987:Gonadotropin-Releasing Hormone; D004958:Estradiol; D016729:Leuprolide