Clinical Assisted Reproduction
1996
Purpose: Our purpose was to evaluate the IVF-ET outcome
in patients who did not achieve timely pituitao,-ovarian
suppression following "long"-protocol GnRH agonist
( GnRH-a ) administration.
Methods: A retrospective analysis was done on 96 IVF
treatment cycles characterized by a delayed response (DR) to
long-protocol GnRH-a treatment. The study included those
patients who either achieved ovarian suppression (E2 <-- 110
pM) despite an elevated LH level (group DR-A) or had
pituita~' desensitization (LH <- 1.5 IUIL) without ovarian
suppression (group DR-B) on day 12 of GnRH-a treatment
but needed an extended course of GnRH-a treatment to
achieve complete suppression. These patients had gonado-
tropin stimulation either from day 12, despite an elevated
level of LH (subgroup DR-A 1; n = 13) or elevated E~ levels
(subgroup DR-BI; n = 9), or after achieving a complete
hypogonadotropic-hypopgonadal state following an
extended course of GnRH-a treatment [subgroups DR-A2 (n
= 46) and DR-B2 (n = 28)1. The outcome was compared
with that of 88 cycles of normal responders (group NR)
who had pituitary-ovarian suppression by day 12 o f GnRH-
a administration.
Results: Ovarian response and pregnancy rates in subgroups
DR-A 1 and DR-A2 were statistically not different and com-
parable to those in the NR group. In subgroups DR-B1
and DR-B2, E. 2 response and rates of oocyte retrieval and
pregnancy were signoqcantty lower than those in the other
groups, but fertilization and cleavage rates were similar.
The requirement of gonadotropin for ovarian stimulation
was comparatively higher in subgroup DR-A2 and both DR-
B subgroups.
Conclusions: There was no treatment cancellation in group
NR attd both DR-A subgroups, but 22% t~f the cw'les in DR-
BI and 14% of the cycles in DR-B2 were canceled due to
poor ovarian response. It therefore appears that during long-
protocol pituita~, desensitization, the post-GnRH-a level ~
serum E,_, rather than LH, better predicts IVF-ET outcome.
Keywords:
- Correction
- Cite
- Save
- Machine Reading By IdeaReader
16
References
6
Citations
NaN
KQI