Differential effects of gonadotrophin-releasing hormone agonists administered as desensitizing or flare protocols on hormonal function in the luteal phase of hyperstiinulated cycles
| Autor: | X. Wang, G. M. Warnes, C.A. Kirby, Robert J. Norman, C.D. Matthews |
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| Rok vydání: | 1991 |
| Předmět: |
endocrine system
medicine.medical_specialty Menotropins medicine.drug_class media_common.quotation_subject Stimulation Fertilization in Vitro Luteal Phase Luteal phase Chorionic Gonadotropin Clomiphene Gonadotropin-Releasing Hormone Follicle-stimulating hormone Pregnancy Internal medicine medicine Humans Ovulation Progesterone reproductive and urinary physiology media_common Estradiol business.industry Rehabilitation Obstetrics and Gynecology Luteinizing Hormone Endocrinology Reproductive Medicine Pituitary Gland Female Leuprolide Gonadotropin business Luteinizing hormone hormones hormone substitutes and hormone antagonists Hormone |
| Zdroj: | Human Reproduction. 6:206-213 |
| ISSN: | 1460-2350 0268-1161 |
| DOI: | 10.1093/oxfordjournals.humrep.a137307 |
| Popis: | The incorporation of gonadotrophin-releasing hormone agonist (GnRHa) in in-vitro fertilization (IVF) stimulation protocols has led to doubt about the quality of the subsequent luteal phase. The effects of two GnRHa stimulation protocols on luteal phase concentrations of oestradiol (E2), progesterone (P), luteinizing hormone (LH) and follicle stimulating hormone (FSH) were compared with the standard clomiphene stimulation regimen. Subjects receiving clomiphene with human menopausal gonadotrophin (HMG, n = 377) showed essentially similar luteal phase P concentrations to those receiving leuprolide acetate/HMG as a desensitization protocol. Subjects receiving concomitant leuprolide and HMG from day 2 to utilize the flare effect of the GnRHa exhibited significantly lower P levels in the luteal phase compared to clomiphene/HMG and leuprolide desensitization protocols despite the addition of HCG support. This occurred despite equivalent E2 concentrations at the time of ovulation and identical numbers of oocytes recovered. LH concentrations in non-conception cycles were suppressed for at least 14 days in the luteal phase in both GnRHa protocols compared to clomiphene stimulation. Differences were less obvious in cycles where conception occurred suggesting that implantation may proceed more favourably when the luteal endocrinology was optimal. It is concluded that flare methods of GnRHa hyperstimulation are associated with significantly different luteal phases compared with clomiphene or desensitization protocols. It is proposed that the use of the flare type of stimulation may significantly influence the response of the granulosa cells to LH or HCG via gonadotrophin receptors or through altered post-receptor function. |
| Databáze: | OpenAIRE |
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