The efficacy of a combination administration of gonadotropin-releasing hormone agonist and gonadotropins for controlled ovarian hyperstimulation in IVF program.

In 105 patients with the past history of poor response to the previous controlled ovarian hyperstimulation (COH) due to poor follicular growth or premature LH surge, the efficacy of pituitary suppression with gonadotropin-releasing hormone agonist (GnRHa) in IVF/GIFT program was evaluated in 112 cycles of COH using a combination regimen of leuprolide acetate (Lupron) and FSH/hMG or pure FSH from May to December, 1989. After suppression phase, serum E2 and progesterone levels decreased significantly, but there was no change in serum LH and FSH levels. There was no occurrence of premature LH surge during COH. Eleven cycles (9.8%) were cancelled, and 3 cycles (3.0%) failed in the transvaginal oocytes retrieval. The 7.00 +/- 3.32 follicles (FD greater than or equal to 12 mm) were observed, and 6.11 +/- 4.15 oocytes were retrieved. The 3.59 +/- 2.57 oocytes were fertilized and cleaved with the cleavage rate of 55.7%. In 83 IVF patients, 4.08 +/- 2.39 embryos were transferred, and 16 pregnancies were obtained with the pregnancy rate per ET of 19.3%. In 6 GIFT patients, 7.83 +/- 3.31 oocytes were available for transfer. When compared with the previous 108 cycles, the cancellation rate during COH was decreased and all the parameters of the outcome of COH including the pregnancy rate were increased. These data suggest that GnRHa therapy for pituitary suppression is an effective adjunct to the current gonadotropin regimens for COH in IVF/GIFT and can increase the probability of oocytes retrieval and pregnancy, especially in the previous poor responders.