Premature luteinization of follicles during ovarian stimulation for in-vitro fertilization

Abstract

The structure and growth of developing follicles was monitored using vaginal ultrasound scanning in an outpatient programme of in-vitro fertilization (IVF) and embryo transfer (ET). Patients received either human menopausal gonadotrophin (HMG) alone or clomiphene citrate (CC) + HMG for controlled ovarian stimulation. Ultrasound data were compared with pre-ovulatory oestradiol (E2), luteinizing hormone (LH) and progesterone (P) levels. Hormonal parameters and results were classified according to the main indications of IVF-ET treatment. Twenty-one of the 271 patients in the study showed ultrasonic evidence of premature luteinization (PL) of follicles, thickening of the follicular wall and the appearance of irregular echogenic structures in the follicle. PL was preceded in eight cases by an indisputable LH surge and subsequent P elevation. In the remaining 13 cases PL occurred either due to an abortive LH surge not exceeding by 3-fold the baseline values or as a result of HMG administration. Special attention was paid to the P pattern prior to and after human chorionic gonadotrophin (HCG) administration. PL cycles demonstrated significantly (P less than 0.05) higher P levels before HCG administration and at the time of oocyte retrieval as well. Because implantation was not achieved in these cases, the cancellation of PL cycles is recommended. Vaginal ultrasound scanning seems to be helpful in the evaluation of minor changes in the follicular structure, correlating frequently with hormonal findings.

Progesterone rise on the day of HCG administration (premature luteinization) in IVF: An overdue update

“…Vaginal ultrasound scanning seems to be helpful in the evaluation of minor changes in the follicular structure, correlating frequently with hormonal findings [16]. Ultrasonic features of PL of follicles are thickening of the follicular wall and the appearance of irregular echogenic structures in the follicle.…”

Isolation and identification of genes differentially expressed in premature luteinization granulosa cell during controlled ovarian hyperstimulation

“…Premature serum P elevation on or before the day of hCG administration during controlled ovarian hyperstimulation (COH) and the concomitant differentiation of granulosa cells (GC) to luteal cells is usually called premature luteinization (PL) (1). Despite the introduction of GnRH analogue into clinical practice and the effective suppression of endogenous gonadotropins, the prevalence rate of premature luteinization in long GnRH agonist (GnRH-a) cycles has been reported from 13% (2) -61% (3).…”

First Irish birth following IVF therapy using antagonist protocol

“…Since then, more or less aggressive forms of controlled ovarian stimulation (COH) have been described to increase the oocyte yield and the number of zygotes available for transfer. One initial complication of COH treatments was the presence of premature LH surges resulting in poor IVF outcome [5]. Multiple authors [6,7] have shown the benefits of GnRH-a use in preventing a premature LH surge in IVF.…”