title: Preferred treatment of infertile women older than 37 years of age who demonstrate premature luteinization in the first evaluation cycle.
abstract: OBJECTIVE
  To evaluate the efficacy of various treatments in abolishing premature luteinization in infertile women over 37 years old who are undergoing ovulation induction.
  
  
  METHODS
  Prospective, nonrandomized study.
  
  
  METHODS
  Tertiary care medical clinic.
  
  
  METHODS
  Seventeen infertile women >37 years old in whom premature luteinization was detected during their evaluation (pretreatment) cycle.
  
  
  METHODS
  The patients underwent three consecutive treatment cycles with clomiphene citrate (group A), hMG (group B), and a GnRH agonist plus hMG (group C).
  
  
  METHODS
  Premature luteinization, defined as a progesterone/E2 ratio of >1 on the day of hCG administration.
  
  
  RESULTS
  Fifteen (88%) of the 17 patients in group A and 13 (76%) of the 17 patients in group B demonstrated premature luteinization. In contrast, only 1 (6%) of the 17 patients in group C had a progesterone/E2 ratio of >1 on the day of hCG administration. The mean (+/-SD) E2 level on the day of hCG administration was significantly higher in group C (1.236 +/- 772.7 pg/mL) than in group A (214.02 +/- 104.46 pg/mL) or group B (412.5 +/- 337 pg/mL).
  
  
  CONCLUSIONS
  Pituitary desensitization with a GnRH agonist in conjunction with hMG may be of benefit for older infertile women who demonstrate early luteinization in their first evaluation cycle.
authors.affiliation: Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel.
authors.forename: A L
authors.initials: AL
authors.lastname: Lidor
authors.forename: S B
authors.initials: SB
authors.lastname: Cohen
authors.forename: D S
authors.initials: DS
authors.lastname: Seidman
authors.forename: S
authors.initials: S
authors.lastname: Mashiach
authors.forename: S
authors.initials: S
authors.lastname: Lipitz
authors.forename: M
authors.initials: M
authors.lastname: Goldenberg
mesh_terms: D000328:Adult; D006063:Chorionic Gonadotropin / Q000008:administration & dosage; D002996:Clomiphene / Q000008:administration & dosage; D005260:Female; D005498:Follicular Phase / Q000187:drug effects* / Q000502:physiology*; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists; D006801:Humans; D007247:Infertility, Female / Q000628:therapy*; D008423:Maternal Age; D008596:Menotropins / Q000008:administration & dosage; D008875:Middle Aged; D006080:Ovarian Follicle / Q000187:drug effects / Q000502:physiology; D010062:Ovulation Induction; D018566:Pregnancy, High-Risk; D011374:Progesterone / Q000097:blood; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D006063:Chorionic Gonadotropin; D002996:Clomiphene; D007987:Gonadotropin-Releasing Hormone; D011374:Progesterone; D008596:Menotropins