Preferred treatment of infertile women older than 37 years of age who demonstrate premature luteinization in the first evaluation cycle.
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.
Lidor
A L
AL
Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel.
Cohen
S B
SB
Seidman
D S
DS
Mashiach
S
S
Lipitz
S
S
Goldenberg
M
M
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
D006063:Chorionic Gonadotropin; D002996:Clomiphene; D007987:Gonadotropin-Releasing Hormone; D011374:Progesterone; D008596:Menotropins