Substituting human chorionic gonadotropin by gonadotropin-releasing hormone agonist to trigger final follicular maturation, during controlled ovarian hyperstimulation, results in less systemic inflammation.
BACKGROUND
To investigate the degree of systemic inflammation, as reflected by serum C-reactive protein (CRP) levels, associated with controlled ovarian hyperstimulation (COH) with human chorionic gonadotropin (hCG) or gonadotropin-releasing hormone (GnRH) agonist for the induction of final follicular maturation.


METHODS
Prospective, observational study.


METHODS
An in vitro fertilization (IVF) unit of an academic medical center.


METHODS
Twenty-four women undergoing COH and IVF with the flexible GnRH antagonist protocol were prospectively assigned to receive hCG or GnRH agonist for the induction of final follicular maturation.


METHODS
Blood was drawn three times during COH for measurement of sex-steroid and CRP levels: the day on which adequate suppression was obtained (Day-0); the day of or prior to administration of hCG (Day-hCG); and (3) the day of ovum pick-up (Day-OPU). Levels were compared among the three time points in the two groups.


RESULTS
No between-group differences were observed in terms of patient age, gonadotropin dosage, duration of stimulation or number of oocytes retrieved. Serum CRP levels were significantly higher on Day-OPU than on Day-hCG and Day-0, but the difference was significant only in the hCG group (p<0.03 for both). The percentage change in CRP levels after hCG administration (Day-OPU vs. Day-hCG) (96%) was higher than that after GnRH administration (23%).


CONCLUSIONS
Administration of GnRH agonist in patients undergoing COH for IVF yields a lesser degree of systemic inflammation, as reflected by CRP levels, than hCG.
Orvieto
Raoul
R
Helen Schneider Hospital for Women, Rabin Medical Center, Petah Tiqwa and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. raoulo@barzi.health.gov.il
Zagatsky
Irina
I
Yulzari-Roll
Vered
V
La Marca
Antonio
A
Fisch
Benjamin
B
D000328:Adult; D002097:C-Reactive Protein / Q000032:analysis; D002452:Cell Count; D006063:Chorionic Gonadotropin / Q000494:pharmacology*; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods; D005498:Follicular Phase / Q000187:drug effects*; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists*; D006062:Gonadotropins / Q000627:therapeutic use; D006801:Humans; D007249:Inflammation / Q000209:etiology*; D010062:Ovulation Induction / Q000009:adverse effects* / Q000379:methods*; D010063:Ovum / Q000166:cytology / Q000187:drug effects
D006063:Chorionic Gonadotropin; D006062:Gonadotropins; D007987:Gonadotropin-Releasing Hormone; D002097:C-Reactive Protein