Suppression and flare regimens of gonadotropin-releasing hormone agonist. Use in women with different basal gonadotropin values in an in vitro fertilization program.
OBJECTIVE
To evaluate the suppression and flare regimens of gonadotropin-releasing hormone agonist (GnRH-a) in ovarian hyperstimulation in women with variable basal gonadotropin values in an in vitro fertilization (IVF) program.


METHODS
A retrospective study comparing the initiation of GnRH-a in the midluteal phase of the preceding cycle (suppression protocol) and follicular phase of the stimulated cycle (flare protocol) in women with basal follicle-stimulating hormone (FSH) values < 15 mIU/mL and > or = 15 mIU/mL.


RESULTS
The pregnancy rate per initiated cycle and implantation rate for women with basal FSH levels > or = 15 mIU/mL were 20.4% and 9.8% in flare GnRH-a cycles and 11.7% and 3.5%, respectively, in suppression GnRH-a cycles. Comparing the percent differences in clinical pregnancy and implantation rates between both protocols for women with different basal FSH values, pregnancy outcome was significantly greater in the flare protocols in women with values > or = 15 mIU/mL (P < .001). Individualization of the stimulation protocol by retrospective sorting of women undergoing IVF with respect to their basal gonadotropin levels significantly improved clinical pregnancy (P < .05) and implantation rates (P < .05) and reduced the cancellation rate (P < .05).


CONCLUSIONS
The flare regimen with GnRH-a is a useful alternative for controlled ovarian hyperstimulation in women with elevated basal FSH values (> or = 15 mIU/mL) undergoing IVF.
Toth
T L
TL
Vincent Memorial Gynecology and Obstetrics Service, Massachusetts General Hospital, Harvard Medical School, Boston 02114, USA.
Awwad
J T
JT
Veeck
L L
LL
Jones
H W
HW
Muasher
S J
SJ
D000328:Adult; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods*; D005640:Follicle Stimulating Hormone / Q000097:blood; D005498:Follicular Phase / Q000502:physiology; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists*; D006062:Gonadotropins / Q000097:blood*; D006801:Humans; D016729:Leuprolide / Q000494:pharmacology*; D008597:Menstrual Cycle / Q000502:physiology; D010053:Ovary / Q000502:physiology; D011247:Pregnancy; D018873:Pregnancy Rate; D011863:Radioimmunoassay; D012189:Retrospective Studies
D006062:Gonadotropins; D007987:Gonadotropin-Releasing Hormone; D005640:Follicle Stimulating Hormone; D016729:Leuprolide