Suppression of the endogenous luteinizing hormone surge by the gonadotrophin-releasing hormone antagonist Cetrorelix during ovarian stimulation

Abstract

Surges of luteinizing hormone (LH) that result in luteinization but occur prematurely with respect to the diameter of the leading follicle, prevent attempts to induce multiple follicular maturation for in-vitro fertilization (IVF) in a significant number of women. We examined the possibility of blocking premature LH surges by the administration of Cetrorelix, a potent antagonist of gonadotrophin-releasing hormone (GnRH), in a study including 20 patients, some of whom had previously shown premature LH surges. All patients were treated with human menopausal gonadotrophins (HMG) starting on day 2. From day 7 until the induction of ovulation by human chorionic gonadotrophin (HCG) the GnRH antagonist Cetrorelix was given daily. HCG was injected when the dominant follicle had reached a diameter of > or = 18 mm and oestradiol concentration was > 300 pg/ml for each follicle having a diameter of > 15 mm. Oocyte collection was performed 36 h later by transvaginal ultrasound puncture, followed by IVF and embryo transfer. The hormone profiles of these patients and the results of IVF and embryo transfer are comparable to those treated with GnRH agonists and HMG. However, less time and especially less HMG is needed in comparison to patients stimulated with a long agonist protocol. Hence, treatment with Cetrorelix proved to be much more comfortable for the patient. In this study we showed that combined treatment with gonadotrophins and the GnRH antagonist Cetrorelix is a promising method for ovarian stimulation in patients who frequently exhibit premature LH surges and therefore fail to complete treatment.

The decrease of serum luteinizing hormone level by a gonadotropin-releasing hormone antagonist following the mild IVF stimulation protocol for IVF and its clinical outcome

“…Williams et al reported a cancellation rate of 0%; thus, proving the validity of a GnRH antagonist for IVF [3]. Several injection methods for a GnRH antagonist have been reported, such as a single 3-mg injection of a GnRH antagonist [8], or a daily injection of 0.25mg of a GnRH antagonist [4,7,9,10]. Although the number of retrieved oocytes is lower than that of the long-protocol method, which uses a GnRH agonist, there was no significant difference in the clinical pregnancy rate [3,11].…”

THE USE OF GnRH ANTAGONISTS IN OVARIAN STIMULATION FOR INTRAUTERINE INSEMINATION

“…The efficacy of these agents in preventing premature LH surge has been demonstrated (1) . Several studies have also demonstrated that GnRH antagonists decrease the premature luteinization rates and cycle cancellation rates (12,13) .…”

“…Gonadotropin-releasing hormone (GnRH) antagonists have been recently introduced in clinical practice for ovarian stimulation in assisted reproduction cycles (1) .…”

Usefulness of Measuring Serum LH Concentration on Day 1 Before Ovarian Stimulation in Non- Obese Polycystic Cases

“…LH plays a role in both oocyte maturation and ovulation through a mechanism which is poorly understood (1).Granulosa cells acquire LH receptors by the mid follicular phase of the menstrual cycle coinciding with a rise in LH level (2) and a premature LH surge may cause early luteinization and follicular atresia in cases of controlled ovarian stimulation (3) . High LH levels causes premature secretory transformation of the endometrium decreasing the chances of implantation and thereby decreasing pregnancy rates [4][5][6] .…”