Ovarian stimulation for in vitro fertilization using pure follicle-stimulating hormone with and without gonadotropin-releasing hormone agonist in high-responder patients

Michael C. Edelstein, Robert G. Brzyski, Georgeanna S. Jones, Sergio Oehninger, Susan M. Sieg, Suheil J. Muasher

Research output: Contribution to journalArticle

Abstract

There is a distinct pattern of response to gonadotropin stimulation in some patients marked by high peak estradiol (E2) levels, multifollicular ovarians response, and elevated basal luteinizing hormone (LH)/follicle-stimulating hormone (FSH) ratios. We reviewed the stimulation profiles of five such high-responder patients who failed to conceive during in vitro fertilization with ovarian stimulation using pure FSH. All patients had baseline LH/FSH >1.5 and peak E2>800 pg/ml. One cycle was canceled prior to hCG administration because of marked ovarian response (E2>2500 pg/ml, multiple small follicles). In a subsequent cycle, all patients were pretreated with the gonadotropin releasing-hormone agonist (GnRHa) leuprolide acetete for 10-14 days prior to initiation of FSH for ovarian stimulation. Leuprolide was continued until the day of hCG administration. During cycles using GnRHa, there was a statistically significant decrease (P <0.05) in serum FSH on day 3 (<5 vs 8.3 mIU/ml), serum E2 on day 3 (14.6 vs 34.6 pg/ml), and peak serum E2 (1197.6 vs 1923.0 pg/ml). Patients during cycles with GnRHa had a greater number of preovulatory (8.6 vs 3.0) and total (12.4 vs 6.0) oocytes retrieved (P<0.05). The fertilization rate of preovulatory oocytes was also higher during cycles using GnRHa (83 vs 64%). Two pregnancies occurred in the cycles pretreated with GnRHa. These preliminary data indicate that in high-responder patients, a combination of GnRHa and pure FSH results in lower E2 levels during the stimulation cycle and a greater number of total and mature oocytes retrieved and fertilized.

Original languageEnglish (US)
Pages (from-to)172-176
Number of pages5
JournalJournal of In Vitro Fertilization and Embryo Transfer
Volume7
Issue number3
DOIs
StatePublished - Jun 1 1990

Keywords

  • follicle-stimulating hormone
  • gonadotropin-releasing hormone agonist
  • human in vitro fertilization
  • ovarian stimulation

ASJC Scopus subject areas

  • Reproductive Medicine
  • Embryology
  • Obstetrics and Gynecology
  • Developmental Biology

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