Journal of Assisted Reproduction and Genetics

, Volume 12, Issue 3, pp 167–174 | Cite as

Ovulation triggering in clomiphene citrate-stimulated cycles: Human chorionic gonadotropin versus a gonadotropin releasing hormone agonist

  • Cecilia Schmidt-Sarosi
  • Dinah R. Kaplan
  • Peter Sarosi
  • Mitchell N. Essig
  • Frederick L. Licciardi
  • Martin Keltz
  • Mortimer Levitz
Clinical Assisted Reproduction



To compare the use of human chorionic gonadotropin (hCG) to a gonadotropin releasing hormone (GnRH) agonist, nafarelin, in initiating ovulation and supporting the luteal phase after priming with clomiphene.


In 26 infertile women 50 mg clomiphene citrate produced a preovulatory-size follicle. Then, 11 women were randomized to receive two 400-μg doses of nafarelin intranasally 16 h apart, and 15 women were injected intramuscularly with 5000 IU of hCG (luteal day 0 = LD0). Starting on LD6, 7 more 400-μg doses of nafarelin were repeated on an every 16-h schedule or a single 2500 IU dose of hCG was given, respectively. Serum levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), progesterone (P), and hCG were measured. On LD13, endometrium was evaluated with ultrasonography and biopsy in 19 nonpregnant women.


As judged by a threefold rise in serum LH, an LH surge was detected on LD1 in all 11 nafarelin patients, but in only 8 hCG patients (P = 0.01). LH and FSH levels were significantly higher on LD1, 7, and 8 and were significantly suppressed on LD13 in the nafarelin group. All patients had mid-luteal P levels greater than 10 ng/ml and luteal phases longer than 13 days. Significantly different luteal E2 or P levels were noted only on LD13, with lower values in the nafarelin group. Pregnancies were achieved in 3 of 11 nafarelin cycles and 2 of 15 hCG cycles. Luteal phase defects were also similar: 4 of 8 nafarelin patients and 7 of 11 hCG patients.


Nafarelin or hCG in conjunction with clomiphene can result in viable pregnancies, but is associated with low pregnancy rates and a high incidence of luteal phase defects.

Key words

hCG GnRH agonists nafarelin clomiphene luteal phase defects 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Gonen Y, Balakier H, Powell W, Casper P: Use of gonadotropin-releasing hormone agonist to trigger follicular maturation for in vitro fertilization. J Clin Endocrinol Metab 1990;71:918–922PubMedGoogle Scholar
  2. 2.
    Tulchinsky D, Nash H, Brown K, Paoletti-Falcone V, Polcaro J: A pilot study of the use of gonadotropin-releasing hormone analog for triggering ovulation. Fertil Steril 1991;55:644–664PubMedGoogle Scholar
  3. 3.
    Corson SL, Batzer FR, Gocial B, Maislin G: The luteal phase after ovulation induction with human menopausal gonadotropin and one versus two doses of a gonadotropin-releasing hormone agonist. Fertil Steril 1993;59:1251–1256PubMedGoogle Scholar
  4. 4.
    Hammond MG: Monitoring techniques for improved pregnancy rates during clomiphene ovulation induction. Fertil Steril 1984;42:499–509PubMedGoogle Scholar
  5. 5.
    Deaton JL, Gibson M, Blackmer KM, Nakajima ST, Badger GJ, Brumsted JR: A randomized, controlled trial of clomiphene citrate and intrauterine insemination in couples with unexplained infertility or surgically corrected endometriosis. Fertil Steril 1990;54:1083–1088PubMedGoogle Scholar
  6. 6.
    Hammond MG, Halme JK, Talbert LM: Factors affecting the pregnancy rate in clomiphene citrate induction of ovulation. Obstet Gynecol 1983;62:196–202PubMedGoogle Scholar
  7. 7.
    Grazi RV, Taney FH, Gagliardi CL, Von Hagen S, Weiss G, Schmidt CL: Effects of two human chorionic gonadotropin regimens. Fertil Steril 1991;55:1088–1092PubMedGoogle Scholar
  8. 8.
    Hoff JD, Quigley ME, Yen SSC: Hormonal dynamics at midcycle: a reevaluation. J Clin Endocrinol Metab 1983;57:792–796PubMedGoogle Scholar
  9. 9.
    Damewood MD, Shen W, Zacur HA, Schlaff WE, Rock A, Wallach EE: Disappearance of exogenously administered human chorionic gonadotropins. Fertil Steril 1989;52:398–400PubMedGoogle Scholar
  10. 10.
    Noyes RW, Hertig AT, Rock J: Dating the endometrium. Fertil Steril 1950;1:3–25Google Scholar
  11. 11.
    Martin M: Ovulation augmentation in the normally ovulatory women. Sem Reprod Endocrinol 1993;11:209–216Google Scholar
  12. 12.
    Schmidt-Sarosi C: GnRH agonists in in vitro fertilization and embryo transfer. Infert Reprod Med Clin North Am 1993;4:83–98Google Scholar
  13. 13.
    Itskovitz J, Boldes R, Levron J, Erlik Y, Kahana L, Brandes JM: Induction of preovulatory luteinizing hormone surge and prevention of ovarian hyperstimulation syndrome by gonadotropin-releasing hormone agonist. Fertil Steril 1991;56:213–220PubMedGoogle Scholar
  14. 14.
    Itskovitz-Eldor J, Levron J, Kol S: Use of gonadotropin-releasing hormone agonist to cause ovulation and prevent the ovarian hyperstimulation syndrome. Clin Obstet Gynecol 1993;36:701–710PubMedGoogle Scholar
  15. 15.
    Imoedemhe DAG, Sigue AB, Pacpaco ELA, Olazo AB: Stimulation of endogenous surge of luteinizing hormone with gonadotropin-releasing hormone analog after ovarian stimulation for in vitro fertilization. Fertil Steril 1991;55:328–332PubMedGoogle Scholar
  16. 16.
    Henzl MR, Corson SL, Moghissi K, Buttram VC, Berqvist C, Jacobson J: Administration of nasal nafarelin as compared with oral danazol for endometriosis. New Engl J Med 1988,318:485–489PubMedGoogle Scholar
  17. 17.
    Casper RF, Sheehan KL, Yen SSC: Gonadotropin-estradiol responses to a superactive luteinizing hormone-releasing hormone agonist in women. J Clin Endocrinol Metab 1980;50:179–181PubMedGoogle Scholar

Copyright information

© Plenum Publishing Corporation 1995

Authors and Affiliations

  • Cecilia Schmidt-Sarosi
    • 1
  • Dinah R. Kaplan
    • 1
  • Peter Sarosi
    • 2
  • Mitchell N. Essig
    • 2
  • Frederick L. Licciardi
    • 1
  • Martin Keltz
    • 1
  • Mortimer Levitz
    • 1
  1. 1.Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and InfertilityNew York University School of MedicineNew York
  2. 2.Department of Obstetrics and GynecologyBeth Israel Medical CenterNew York

Personalised recommendations