Is routine use of combined gonadotropin releasing hormone analog/human menopausal gonadotropin for IVF justified?

Z. Ben-Rafael, D. Bider, M. Zolti, Y. Menashe, J. Shalev, S. Mashiach

Research output: Contribution to journalArticlepeer-review

Abstract

The rationale for combining gonadotropin hormone releasing hormone analog (GnRH-a) before and during ovarian stimulation with human menopausal gonadotropin (hMG) is based on the concept that hypothalamic amenorrheic women respond better to hMG treatment compared to regularly menstruating women. However the use of GnRH-a is associated with unwarranted effects and does not necessarily promise better stimulation or reduction in side effect of hMG. Patients were treated with GnRH-a for 15 days before stimulation with hMG. The main abnormality during the phase of suppression was paradoxical stimulation of follicular growth and cysts formation. These cysts were aspirated and the content was studied. Patients treated with combined GnRH-a/hMG had relative ovarian insensitivity and prolonged follicular phase, due to lower serum FSH compared to control that were untreated with GnRH-a. This effect could be reversed by increasing hMG dose. Other common problems encountered during hMG stimulation like drop in peripheral E2 levels, early luteinization and ovarian hyperstimulation were not abolished by GnRH-a. Intensive monitoring during the period of suppression, stimulation and luteal phase will detect most of these abnormalities. GnRH-a should be used under defined indication rather than routinely.

Original languageEnglish
Pages (from-to)271-278
Number of pages8
JournalAdvances in Contraceptive Delivery Systems
Volume5
Issue number3-4
StatePublished - 1989

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