Abstract
Purpose
To describe our preliminary experience with the addition of a GnRH antagonist (Nal-Glu) and exogenous gonadotropins (follicle stimulating hormone; FSH) to unstimulated IVF cycles.
Method
Seven spontaneously ovulatory women underwent eight unstimulated IVF cycles at our institution. They were treated with a single dose of Nal-Glu, 50 Μg/ kg, or with a combination of Nal-Glu, 50 Μg/kg, and exogenous FSH, 150–300 IU, during the late follicular phase of spontaneous cycles. They then received 10,000 IU of human chorionic gonadotropin (hCG) to time accurately follicle aspiration in unstimulated IVF cycles.
Results
Two women underwent three cycles with Nal-Glu alone on the day of hCG administration. One pregnancy resulted. Five women underwent five cycles with 3 to 6 days of daily Nal-Glu and FSH. Four of these cycles resulted in aspiration after the FSH dose was increased to 300 IU. Nal-Glu and FSH allowed continued development of the dominant follicle without the occurrence of luteinizing hormone (LH) surge.
Conclusions
(1) Nal-Glu alone given 18 hr prior to hCG did not interfere with continued follicle viability or with the attainment of pregnancy. (2) Simultaneous Nal-Glu and FSH allowed for continued growth and development of the dominant follicle without the occurrence of an LH surge. (3) This preliminary experience confirms the feasibility of this novel approach, which may ultimately enhance the efficacy of unstimulated IVF cycles by eliminating premature ovulation and maximizing control of gonadotropin delivery to the developing follicle.
Similar content being viewed by others
References
Paulson RJ, Sauer MV, Francis MM, Macaso TM, Lobo RA: In vitro fertilization in unstimulated cycles: A clinical trial using hCG for timing of follicle aspiration. Obstet Gynecol 1990;76:788
Paulson RJ, Sauer MV, Francis MM, Macaso TM, Lobo RA: In vitro fertilization in unstimulated cycles: The University of Southern California experience. Fertil Steril 1992;57:290
Foulot H, Ranoux X, Dubuisson JB, Rambaud D, Aubriot FX, Poirot C: In vitro fertilization without ovarian stimulation: A simplified protocol applied in 80 cycles. Fertil Steril 1989;52:617
Claman P, Domingo M, Garner P, Leader A, Spence JEH: Natural cycle in vitro fertilization-embryo transfer at the University of Ottawa: An inefficient therapy for tubal infertility. Fertil Steril 1993;60:298
Whittemore AS, Harris R, Itnyre J: Characteristic relating to ovarian cancer risk: Collaborative analysis of 12 US casecontrol studies. Am J Epidemiol 1992;136:1184
Ditkoff EC, Cassidenti DL, Paulson RJ, Sauer MV, Paul WL, Lobo RA: The GnRH antagonist Nal-Glu acutely blocks the LH surge but allows for resumption of folliculogenesis in normal women. Am J Obstet Gynecol 1991;165:1811
Cassidenti DL, Sauer MV, Paulson RJ, Ditkoff EC, Lobo RA: Comparison of the use of the gonadotropin-releasing hormone (GnRH) antagonist (Nal-Glu) to GnRH agonist in in vitro fertilization cycles. Am J Obstet Gynecol 1991;165:1806
Cassidenti DL, Paulson RJ, Lobo RA, Sauer MV: The synergistic effects of clomiphene citrate and human menopausal gonadotrophin in the folliculogenesis of stimulated cycles as assessed by the gonadotrophin-releasing hormone antagonist Nal-Glu. Hum Reprod 1992;7:344
Mortola JF, Sathanandan M, Pavlou S, Dahl ED, Hseuh AJW, Rivier J, Vale W, Yen SSC: Suppression of bioactive and immunoreactive follicle-stimulating hormone and luteinizing hormone levels by a potent gonadotropin-releasing hormone antagonist: pharmacodynamic studies. Fertil Steril 1989;51:957
Paulson RJ, Sauer MV, Francis MM, Macaso TM, Lobo RA: Factors affecting pregnancy success of human in vitro fertilization in unstimulated cycles. Human Reprod (in press)
Shoham Z, Balen A, Patel A, Jacobs HS: Results of ovulation induction using human menopausal gonadotropin or purified follicle-stimulating hormone in hypogonadotropic hypogonadism patients. Fertil Steril 1991;56:1048
Dodson WC, Myers T, Morton PC, Conn PM: Leuprolide acetate: Serum and follicular fluid concentrations and effects on human fertilization, embryo growth, and granulosa-lutein cell progesterone accumulation in vitro. Fertil Steril 1988;50:612
Frederick JL, Hickey MJ, Francis-Hernandez MM, Sauer MV, Paulson RJ: Effect of leuprolide acetate on steroidogenesis by granulosa and theca cells in vitro. J Vitro Fert Embryo Transfer 1991;8:230
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Paulson, R.J., Sauer, M.V. & Lobo, R.A. Addition of a gonadotropin releasing hormone (GnRH) antagonist and exogenous gonadotropins to unstimulated in vitro fertilization (IVF) cycles: Physiologic observations and preliminary experience. J Assist Reprod Genet 11, 28–32 (1994). https://doi.org/10.1007/BF02213694
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02213694