Advertisement

Pituitary down-regulation using leuprolide for the intensive ovulation management of poor prognosis patients having in vitro fertilization (IVF)-related treatments

  • James M. Cummins
  • Jeanne M. Yovich
  • W. Rohini Edirisinghe
  • John L. Yovich
Special Contributions

Abstract

A review of 118 treatment cycles in 115 women under prolonged GnRH analogue (GnRHa; leuprolide) treatment is presented. Patients were selected for treatment primarily on the grounds of poor previous response to stimulation (n=40). advanced age (>35 years; n=29), previous premature luteinizing hormone (LH) surge (n=30), polycystic ovarian disease (PCO; n=12), and elevaved androgens without evidence of PCO (n=5). An overall pregnancy rate of 28.8% per treatment cycle was attained, compared with a pregnancy rate of 6.2% (6/97, of which none went to term) in the previous completed treatment cycle for the same patients. Ovarian response, as measured by oocytes recovered and maximum estradiol levels observed, was significantly improved in all groups and this was associated with a prolonged follicular phase, significantly more human menopausal gonadotropin (hMG) stimulation and a relatively high incidence of ovarian hyperstimulation, particularly in pregnant patients Of specific techniques in the GnRHa cycle, GIFT produced a pregnancy rate per treatment of 50% (10/20); IVF-ET, 22% (8/36); PROST, 28% (13/46); and TEST 19% (3/16). No cyles were abandoned, compared with a cancellation rate of 24% in previous cycles without GnRHa. Patients with PCO performed paricularly well on GnRHa management, with a pregnancy rate per treatment of 58% (7/12). Pregnancy rates per treatment for the other groups were as follows: elevated age, 27% (9/33), high androgen, 40% (2/5); premature LH surges, 32% (9/28); and poor responders, 17.5% (7/40). A comparison using patients undertaking IVF-ET cycles in 1987 and 1988 shows that the use of GnRHa treatment in the poorprognosis groups lifts their performance into line with that seen in the “good”-prognosis groups. We conclude that pituitary down-regulation with GnRHa (long regimen) offers significant advantages for ovarian management in most groups of infertility patients and it is now being evaluated for routine use in the majority of cases in our practice.

Key Words

Lucrin ovulation induction assisted conception pregnancy in vitro fertilization 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Fleming R, Adam AH, Barlow DH, Black WP, Macnaughton MC Coutts JRT: A new systematic treatment for infertile women with abnormal hormone profiles. Br J Obstet Gynaecol 1982;89:80–83PubMedGoogle Scholar
  2. 2.
    Fleming R, Haxton MJ, Hamilton MPR, McCune GS, Black WP, Macnaughton MC, Coutts JRT: Successful treatment of infertile women with oligomenorrhoea using a combination of a luteinising hormone releasing hormone agonist and exogenous gonadotrophins. Br J Obstet Gynaecol 1985;92:369–373PubMedGoogle Scholar
  3. 3.
    Fleming R, Coutts JRT: Induction of multiple follicular growth in normally menstruating women with endogenous gonadotrophin suppression. Fertil Steril 1986;45:226–230PubMedGoogle Scholar
  4. 4.
    Wildt L, Diedrich K, van der Ven H, Al Hasani S, Hubner H, Klasen R: Ovarian hyperstimulation for in-vitro fertilization controlled by GNRH agonist administered in combination with human menopausal gonadotrophins. Hum Reprod 1986;1:15–19PubMedGoogle Scholar
  5. 5.
    Smitz J, Devroey P, Braeckmans P, Camus M, Khan I, Staessen C, Van Waesberghe L, Wisanto A, Van Steirteghem AC: Management of failed cycles in an IVF/GIFT programme with the combination of a GnRH analog and HMG. Hum Reprod 1987;2:309–314PubMedGoogle Scholar
  6. 6.
    Macnamee MC, Howles CM, Edwards RG: Pregnancies after IVF when high tonic LH is reduced by long-tern treatment with GnRH agonists. Hum Reprod 1987;2:569–571PubMedGoogle Scholar
  7. 7.
    Macnamee MC, Edwards RG, Howles CM: The influence of stimulation regimes and luteal phase support in the outcome of IVF. Hum Reprod 1988;3(Suppl 2):43–52PubMedGoogle Scholar
  8. 8.
    Neveu S, Hedon B, Bringer J, Chinchole J-M, Arnal F, Humeau C, Cristol P, Viala JL: Ovarian stimulation by a combination of gonadotropin-releasing hormone agonsit and gonadotropins for in vitro fertilization. Fertil Steril 1987;47:639–643PubMedGoogle Scholar
  9. 9.
    Crosignani PG, Ragni G, Lombroso GC, Scarduelli C, De Lauretis L, Caccamo A, Dalpra L, Cavioni V, Cristiani C, Wyssling H, Olivares MD, Perotti L: Ovarian stimulation of IVF patients: Effects of the reversible hypogonadotrophic state induced by GnRH agonist. Hum Reprod 1988;3(Suppl 2):39–41Google Scholar
  10. 10.
    Ferrier AJ, Berkeley AS, Cholst IN: Pretreatment with a subcutaneous gonadotropin-releasing hormone agonist in an in vitro fertilization cycle resulting in a viable pregnancy. J Vitro Fert Embryo Transfer 1988;5:234–236Google Scholar
  11. 11.
    Lehmann F, Baban N, Webber B: Ovarian stimulation for in-vitro fertilization: Clomiphene and HMC. Hum Reprod 1988;3(Suppl 2):11–21Google Scholar
  12. 12.
    Schmutzler RK, Reichert C, Diedrich K, Wildt L, Diedrich Ch, Al-Hasani S, van der Ven H, Krebs D: Combined GnRH-agonist/gonadotrophin stimulation for in-vitro fertilization. Hum Reprod 1988;3(Suppl 2):29–33Google Scholar
  13. 13.
    Serafini P, Stone B, Kerin J, Batzofin J, Quinn P, Marrs RP: An alternate approach to controlled ovarian hyperstimulation in “poor responders”: Pretreatment with a gonadotropin-releasing hormone analog. Fertil Steril 1988;49:90–95PubMedGoogle Scholar
  14. 14.
    Smitz J, Devroey P, Camus M, Khan I, Staessen C, Van Waesberghe L, Wisanto A, Van Steirteghem AC: Addition of Buserelin to human menopausal gonadotrophins in patients with failed stimulations for IVF or GIFT. Hum Reprod 1988:3(Suppl 2):35–38PubMedGoogle Scholar
  15. 15.
    Droesch K, Muasher SJ, Brzyski RG, Jones GS, Simonetti S, Liu HC: Value of suppression with a gonadotropinreleasing hormone agonist prior to gonadotropin stimulation for in vitro fertilization. Fertil Steril 1989;51:292–297PubMedGoogle Scholar
  16. 16.
    Belaisch-Allart J, Testart J, Frydman R: Uthization of GnRH agonists for poor responders in an IVF programme. Hum Repord 1989;4:33–34Google Scholar
  17. 17.
    Meldrum DR, Wisot A, Hamilton F, Gutlay AL, Huynh D, Kempton W: Timing of initiation and dose schedule of lenprolide influence the time course of ovarian suppression. Fertil Steril 1988;50:400–402PubMedGoogle Scholar
  18. 18.
    Brzyski RG, Muasher SJ, Droesch K, Simonetti S, Jones GS, Rosenwaks Z: Follicular atresia associated with concarrent initiation of gonadotropin-releasing hormone agonst and follicle-stimulating hormone for oocyte recruitment. Fertil Steril 1988;50:917–921PubMedGoogle Scholar
  19. 19.
    Testart J, Belaisch-Allart J, Forman R, Gazengel A, Strubb N, Hazout A, Frydman R: Intluence of different stimulation treatments on oocyte characteristics and in-vitro fertilizing ability. Hum Reprod 1989;4:192–197PubMedGoogle Scholar
  20. 20.
    Meldrum DR, Wisot A, Hamilton F, Gutlay AL, Kempton W, Huynh D: Routine pituitary suppression with leuprofide before ovarian stimulation for oocyte retrieval. Fertil Stedl 1989;51:455–459Google Scholar
  21. 21.
    Yovich JL: Tubal transfers: PROST & TEST.In Proceedings of the International Symposium on Gamete Physiology, California, November 6–10, 1988 (in press)Google Scholar
  22. 22.
    Yovich JM, Edirisinghe WR, Cummins JM, Yovich JL: Preliminary results using pentoxifylline in a pronuclear stage tubal transfer (PROST) program for severe male factor infertility. Fertil Steril 1988;50:179–181PubMedGoogle Scholar
  23. 23.
    Yovich JL, Tuvik AI, Matson PL, Willcox DL: Ovanan stimulation in disordered ovulatory cycles. Asia-Ocean J Obstet Gynaecol 1987;13:43–47Google Scholar
  24. 24.
    Yovich JL, Yovich JM, Edirisinghe WR: The relatuve chance of pregnancy following tubal or uterine transfer procedures. Fertil Steril 1988;49:858–864PubMedGoogle Scholar
  25. 25.
    Cummins JM, Breen TM, Harrison KL, Shaw JM, Wilson LM, Hennessey JF: A formula for scoring human embryo growth rates in in vitro fertilization: Its value in predicting pregnancy and in comparison with visual estimates of embryo quality. J Vitro Fert Embryo Transfer 1986;3:284–295Google Scholar
  26. 26.
    Testart J, Forman R, Belaisch-Allart J, Volante M, Hazout A, Strubb N, Frydman R: Embryo quality and uterine receptivity in in-vitro fertilization cycles with or without agonists of gonadotropin-releasing hormone. Hum Reprod 1989;4:198–201PubMedGoogle Scholar
  27. 27.
    Humburg R, Eshel A, Abdalla HI, Jacobs HS: Growth hermone facilitates ovulation induction by gonadotrophins. Clin Endocrinol 1988;29:113–117Google Scholar

Copyright information

© Plenum Publishing Corporation 1989

Authors and Affiliations

  • James M. Cummins
    • 1
    • 2
  • Jeanne M. Yovich
    • 1
    • 2
  • W. Rohini Edirisinghe
    • 1
    • 2
  • John L. Yovich
    • 1
    • 2
  1. 1.PIVET Medical CentrePerth
  2. 2.Department of Obstetrics & GynaecologyUniversity of Western AustraliaPerth

Personalised recommendations