Preferred treatment of infertile women older than 37 years of age who demonstrate premature luteinization in the first evaluation cycle

Objective: To evaluate the efficacy of various treatments in abolishing premature luteinization in infertile women over 37 years old who are undergoing ovulation induction. Design: Prospective, nonrandomized study.Setting: Tertiary care medical clinic. Patient(s): Seventeen infertile women >37 years old in whom premature luteinization was detected during their evaluation (pretreatment) cycle. Intervention(s): The patients underwent three consecutive treatment cycles with clomiphene citrate (group A), hMG (group B), and a GnRH agonist plus hMG (group C). Main Outcome Measure(s): Premature luteinization, defined as a progesterone/E₂ ratio of >1 on the day of hCG administration. Result(s): Fifteen (88%) of the 17 patients in group A and 13 (76%) of the 17 patients in group B demonstrated premature luteinization. In contrast, only 1 (6%) of the 17 patients in group C had a progesterone/E₂ ratio of >1 on the day of hCG administration. The mean (±SD) E₂ level on the day of hCG administration was significantly higher in group C (1,236 ± 772.7 pg/mL) than in group A (214.02 ± 104.46 pg/mL) or group B (412.5 ± 337 pg/mL). Conclusion(s): Pituitary desensitization with a GnRH agonist in conjunction with hMG may be of benefit for older infertile women who demonstrate early luteinization in their first evaluation cycle. Copyright (C) 2000 American Society for Reproductive Medicine.