Effectiveness of cetrorelix for the prevention of premature luteinizing hormone surge during controlled ovarian stimulation using letrozole and gonadotropins: a randomized trial.
OBJECTIVE
To evaluate the effectiveness of a GnRH antagonist in preventing premature LH surge under a letrozole and gonadotropin protocol.


METHODS
Prospective, randomized clinical trial.


METHODS
A teaching hospital and tertiary medical center.


METHODS
Sixty-one patients were randomly assigned into two letrozole and gonadotropin-treated groups. These were distinguished by the absence (group I) or presence (group II) of supplementation with 0.25 mg of cetrorelix.


METHODS
Controlled ovarian stimulation with letrozole and gonadotropins, cetrorelix and intrauterine insemination.


METHODS
Rate of premature LH surge.


RESULTS
Compared with group I, the rate of premature LH surge was statistically significantly lower for group II (43.4% [13/30] vs. 19.4% [6/31]), but the amount of gonadotropins used was statistically significantly higher (817.5 +/- 28.5 vs. 907.5 +/- 27.3 IU). Patients with premature LH surge had a statistically significantly lower pregnancy rate (21.4% [9/42] vs. 0 [0/18]) relative to their unaffected counterparts.


CONCLUSIONS
A flexible protocol of 0.25 mg of cetrorelix for IUI cycles appears to suppress the rate of premature LH surge during ovarian stimulation with letrozole and gonadotropins. However, the incidence of premature LH surge remains too high, and modification will be necessary before the application of cetrorelix to IVF treatment.
Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan.
Tsung-Hsien
TH
Lee
Yu-Hung
YH
Lin
Kok-Min
KM
Seow
Jiann-Loung
JL
Hwang
Chii-Ruey
CR
Tzeng
Yu-Shih
YS
Yang
D000328:Adult; D047072:Aromatase Inhibitors / Q000627:therapeutic use*; D006063:Chorionic Gonadotropin / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D005300:Fertility Agents, Female / Q000627:therapeutic use*; D005307:Fertilization in Vitro; D005640:Follicle Stimulating Hormone / Q000627:therapeutic use; D007987:Gonadotropin-Releasing Hormone / Q000031:analogs & derivatives* / Q000037:antagonists & inhibitors* / Q000627:therapeutic use; D006062:Gonadotropins / Q000627:therapeutic use*; D006727:Hormone Antagonists / Q000627:therapeutic use*; D006801:Humans; D007246:Infertility / Q000097:blood / Q000628:therapy; D000077289:Letrozole; D007986:Luteinizing Hormone / Q000097:blood*; D009570:Nitriles / Q000627:therapeutic use*; D010062:Ovulation Induction / Q000379:methods*; D011247:Pregnancy; D018873:Pregnancy Rate; D011446:Prospective Studies; D011994:Recombinant Proteins / Q000627:therapeutic use; D013624:Taiwan; D016896:Treatment Outcome; D014230:Triazoles / Q000627:therapeutic use*; D015854:Up-Regulation
D047072:Aromatase Inhibitors; D006063:Chorionic Gonadotropin; D005300:Fertility Agents, Female; D006062:Gonadotropins; D006727:Hormone Antagonists; D009570:Nitriles; D011994:Recombinant Proteins; D014230:Triazoles; D007987:Gonadotropin-Releasing Hormone; D000077289:Letrozole; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone; C062876:cetrorelix