Document Detail


GnRHa flare and IVF pregnancy rates.
MedLine Citation:
PMID:  15050465     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: GnRH agonist administered early in the menstrual cycle (flare) causes an endogenous discharge of FSH and LH. Flare has been used in conjunction with gonadotropin ovarian stimulation for IVF 'poor responders'. There is an ongoing controversy regarding whether flare protocols improve pregnancy rates in 'poor responders'. The current study was designed to compare a GnRHa flare protocol with long suppression GnRHa IVF in 'poor responders'. METHODS: Seventy-three newly diagnosed poor responders who failed long GnRHa suppression IVF attempts were compared retrospectively with 128 age-matched IVF patients previously known poor ovarian responders treated with a long GnRHa suppression protocol. 'Poor responders' consisted of patients with peak E(2) less than 1000 pg/ml and/or less than five mature follicles with diameter >15 mm on the day of hCG administration. Student's t-test was used to analyze the data and the chi-squared test was used to compare fertilization and pregnancy rates. RESULTS: The flare protocol produced higher peak E(2) levels (1647+/-747 vs. 720+/-258 mIU/ml, P<0.05) and a larger number of mature follicles (5.8+/-2.2 vs. 4.0+/-1.0 P<0.05) in the study vs. the control group. A 30% pregnancy rate was achieved during this second IVF attempt using GnRHa flare protocol in the study group vs. 37 in the control group (P>0.05, NS). CONCLUSIONS: A comparison between the flare protocol group and the age-matched control group of poor ovarian responders subject to down regulation protocol, revealed higher peak E(2) levels and more mature follicles, respectively. However, both groups yielded comparable pregnancy rates. The use of high dose gonadotropin treatment in our study groups seems to be the only explanation for their subsequent successful outcome. We concluded that GnRH agonist flare protocol does not result in better IVF outcome compared with long GnRH agonist suppression protocol in IVF poor responders.
Authors:
E Confino; X Zhang; R R Kazer
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics     Volume:  85     ISSN:  0020-7292     ISO Abbreviation:  Int J Gynaecol Obstet     Publication Date:  2004 Apr 
Date Detail:
Created Date:  2004-03-30     Completed Date:  2004-08-03     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0210174     Medline TA:  Int J Gynaecol Obstet     Country:  Ireland    
Other Details:
Languages:  eng     Pagination:  36-9     Citation Subset:  IM    
Affiliation:
Department of OB/GYN, Northwestern University Medical School, Chicago, IL, USA. e-confino@northwestern.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Chorionic Gonadotropin / physiology
Clinical Protocols
Female
Fertility Agents, Female / administration & dosage
Fertilization in Vitro*
Follicle Stimulating Hormone, Human / physiology
Gonadotropin-Releasing Hormone / administration & dosage*,  analogs & derivatives*
Humans
Leuprolide / administration & dosage
Ovulation*
Ovulation Induction / methods*
Pregnancy
Pregnancy Rate*
Progesterone / physiology
Retrospective Studies
Chemical
Reg. No./Substance:
0/Chorionic Gonadotropin; 0/Fertility Agents, Female; 0/Follicle Stimulating Hormone, Human; 33515-09-2/Gonadotropin-Releasing Hormone; 53714-56-0/Leuprolide; 57-83-0/Progesterone; 79561-22-1/LHRH, Ala(6)-Gly(10)-ethylamide-

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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