GnRH agonist as novel luteal support: results of a randomized, parallel group, feasibility study using intranasal administration of buserelin.
BACKGROUND
The study objective was to investigate whether repeated intranasal administration of a GnRH agonist could provide convenient and safe luteal support.


METHODS
Twenty-four patients with unexplained infertility were enrolled. All patients were treated with an aromatase inhibitor. When ovulation trigger criteria were met, patients were randomly allocated to either 5000 IU hCG (group A), or 200 microg intranasal buserelin followed by 100 microg every 3 days (group B), 100 microg every 2 days (group C), or 100 microg every day (group D), up to day 14 of the luteal phase. All patients underwent intrauterine insemination.


RESULTS
Follicular development was similar in all groups with 1.1 +/- 0.3 follicles > or = 16 mm, 229.4 +/- 95.2 pg/ml estradiol (E2) and 0.8 +/- 0.5 ng/ml progesterone (mean+/-SD). The luteal phase duration (median; 95% confidence interval) was 15 (14.1, 15.0), 14 (12.5, 15.5), 15 (11.8, 18.2) and 15 (14.4, 15.6) days in groups A, B, C and D respectively. From luteal phase day 7 onwards, progesterone levels tended to be higher in group D compared with A. On day 14 of the luteal phase, progesterone levels were 3.0 (0.8, 5.2), 1.7 (-0.5, 3.9), 3.9 (-0.7, 8.5) and 7.7 (3.4, 11.9) ng/ml in groups A, B, C and D respectively (P = 0.045). No pregnancy was recorded in group A, but there was one biochemical pregnancy in group B, one biochemical and one singleton clinical pregnancy in group C, and two singleton clinical pregnancies in group D.


CONCLUSIONS
Intranasal administration of buserelin could be effective to provide luteal support. This treatment was associated with a good pregnancy rate (5/18, 28%).
Pirard
C
C
Department of Gynecology, Cliniques Universitaires St Luc, Université Catholique de Louvain, B-1200 Brussels, Belgium.
Donnez
J
J
Loumaye
E
E
D000281:Administration, Intranasal; D000328:Adult; D002064:Buserelin / Q000008:administration & dosage*; D006063:Chorionic Gonadotropin / Q000008:administration & dosage; D003340:Corpus Luteum Maintenance / Q000097:blood / Q000187:drug effects*; D004958:Estradiol / Q000097:blood; D005260:Female; D005300:Fertility Agents, Female / Q000008:administration & dosage*; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists*; D006801:Humans; D008183:Luteal Phase / Q000097:blood / Q000187:drug effects; D007986:Luteinizing Hormone / Q000097:blood; D008297:Male; D010062:Ovulation Induction; D011247:Pregnancy; D011374:Progesterone / Q000097:blood; D027724:Reproductive Techniques, Assisted
D006063:Chorionic Gonadotropin; D005300:Fertility Agents, Female; D007987:Gonadotropin-Releasing Hormone; D011374:Progesterone; D004958:Estradiol; D007986:Luteinizing Hormone; D002064:Buserelin