Pituitary down-regulation using leuprolide for the intensive ovulation management of poor prognosis patients having in vitro fertilization (IVF)-related treatments
- 35 Downloads
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 WordsLucrin ovulation induction assisted conception pregnancy in vitro fertilization
Unable to display preview. Download preview PDF.
- 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
- 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.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.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.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
- 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
- 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.Yovich JL: Tubal transfers: PROST & TEST.In Proceedings of the International Symposium on Gamete Physiology, California, November 6–10, 1988 (in press)Google Scholar
- 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
- 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
- 27.Humburg R, Eshel A, Abdalla HI, Jacobs HS: Growth hermone facilitates ovulation induction by gonadotrophins. Clin Endocrinol 1988;29:113–117Google Scholar