IVF pregnancy after induction of an ovulatory endogenous gonadotrophin surge using an LHRH agonist nasal spray

Abstract

A successful human twin IVF pregnancy is reported after using a single 50 micrograms dose of LHRH agonist nasal spray (Buserelin) to induce an ovulatory endogenous gonadotrophin surge 34 h prior to oocyte collection. The couple had 10 years of primary male factor infertility, associated with significant anti-sperm antibodies. The clinical features and endocrine profile are presented.

Basic understanding of gonadotropin-releasing hormone–agonist triggering

“…Lamb et al (7) added a bolus of FSH to the hCG trigger and showed better oocyte recovery and fertilization rates in IVF, compared with use of an hCG trigger alone. As a result of both these differences between a surge triggered naturally vs. with hCG, several groups (8)(9)(10)(11) independently proposed the use of 1 or more bolus injections of GnRH-a to simulate a midcycle gonadotropin surge. The idea behind this proposal was that such a surge might be more physiologic in the release of both LH and FSH, and because of the shorter duration of LH rise, might prevent OHSS (11).…”

“…In 1990, Bentick et al (9) published a case report of the use of a single nasal spray of 50-mg buserelin, resulting in a midcycle surge of LH and FSH that lasted 16 hours, in a patient undergoing an IVF cycle. Mature oocytes were retrieved 34 hours later, and three day 2 were transferred.…”