Pituitary response to early follicular-phase minidose gonadotropin releasing hormone agonist (GnRHa) therapy: evidence for a second flare.
OBJECTIVE
Our purpose was to determine the pituitary response to minidose follicular-phase GnRHa and see if a second flare can be achieved.


METHODS
A prospective, consecutive series of 12 couples with tubal-factor infertility underwent 14 cycles of minidose GnRHa. Women were given a 25- or 50-migrograms dose of leuprolide acetate (LA) on cycle days 2 and 5. On cycle days 3 and 4 no LA was given but 2 ampoules of pure follicle stimulating hormone (FSH) was administered. Beginning day 6, a combination of LA and FSH was administered.


RESULTS
Following a dose of only 25 micrograms of LA on cycle day 2, mean FSH, LH, and E2 levels were significantly elevated over the baseline levels. Following no LA on cycle day 3 or 4, a repeat dose of 25 micrograms LA caused a second flare of LH and E2 on cycle day 6. Of the 14 cycles, 6 were canceled because of poor stimulation. Two of the eight patients who underwent retrieval delivered a live birth.


CONCLUSIONS
This is the first study to examine both the pituitary response and the recovery time from minidose follicular-phase GnRHa. An extremely small dose of LA is needed to cause a pituitary flare of gonadotropins. Following a flare from 25 micrograms of LA on cycle day 2, the pituitary is able to recover and respond with a repeat flare on cycle day 5.
Deaton
J L
JL
Section on Reproductive Endocrinology, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, North Carolina 27157-1067, USA.
Bauguess
P
P
Huffman
C S
CS
Miller
K A
KA
D000328:Adult; D004958:Estradiol / Q000097:blood; D005260:Female; D005300:Fertility Agents, Female / Q000494:pharmacology*; D005307:Fertilization in Vitro; D005640:Follicle Stimulating Hormone / Q000008:administration & dosage / Q000097:blood / Q000494:pharmacology; D005498:Follicular Phase / Q000187:drug effects*; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists*; D006801:Humans; D016729:Leuprolide / Q000008:administration & dosage / Q000494:pharmacology*; D007986:Luteinizing Hormone / Q000097:blood; D008297:Male; D010053:Ovary / Q000187:drug effects; D010902:Pituitary Gland / Q000187:drug effects*; D011247:Pregnancy; D013997:Time Factors
D005300:Fertility Agents, Female; D007987:Gonadotropin-Releasing Hormone; D004958:Estradiol; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone; D016729:Leuprolide