David E Reichman1, Lauren Zakarin2, Kenny Chao1, Laura Meyer1, Owen K Davis1, Zev Rosenwaks3. 1. The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College, New York, New York. 2. Weill Cornell Medical College, New York, New York. 3. The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College, New York, New York. Electronic address: ang2030@med.cornell.edu.
Abstract
OBJECTIVE: To identify risk factors for breakthrough LH surge despite GnRH antagonist (GnRH-ant) suppression in IVF cycles. DESIGN: Case-control study. SETTING: Academic medical center. PATIENT(S): All patients undergoing IVF from August 2004 through July 2012 in whom GnRH-ant pituitary suppression (0.25 mg/d) was used in a flexible protocol. INTERVENTION(S): GnRH-ant-based IVF. MAIN OUTCOME MEASURE(S): Breakthrough LH surges as evidenced by an increase in LH (minimum 2.5-fold increase from baseline above a threshold of 17 mIU/mL) associated with a decrease in E2, and free fluid on ultrasound. RESULT(S): Breakthrough LH surges despite GnRH-ant administration occurred in 37 (0.34%) of the 10,809 antagonist cycles during the study period. Compared with all patients remaining suppressed, patients with breakthrough surges were significantly older and had significantly increased FSH and decreased antral follicle counts. Compared with age-matched controls (allocation ratio, 1:50), significant differences in ovarian reserve remained evident. CONCLUSION(S): The occurrence of a breakthrough LH surge despite GnRH-ant treatment is a reassuringly rare event. However, patients with diminished ovarian reserve are at risk for this outcome despite GnRH-ant down-regulation. Further studies are needed to determine whether these patients can be prospectively identified and whether they may benefit from higher doses of GnRH-ant.
OBJECTIVE: To identify risk factors for breakthrough LH surge despite GnRH antagonist (GnRH-ant) suppression in IVF cycles. DESIGN: Case-control study. SETTING: Academic medical center. PATIENT(S): All patients undergoing IVF from August 2004 through July 2012 in whom GnRH-ant pituitary suppression (0.25 mg/d) was used in a flexible protocol. INTERVENTION(S): GnRH-ant-based IVF. MAIN OUTCOME MEASURE(S): Breakthrough LH surges as evidenced by an increase in LH (minimum 2.5-fold increase from baseline above a threshold of 17 mIU/mL) associated with a decrease in E2, and free fluid on ultrasound. RESULT(S): Breakthrough LH surges despite GnRH-ant administration occurred in 37 (0.34%) of the 10,809 antagonist cycles during the study period. Compared with all patients remaining suppressed, patients with breakthrough surges were significantly older and had significantly increased FSH and decreased antral follicle counts. Compared with age-matched controls (allocation ratio, 1:50), significant differences in ovarian reserve remained evident. CONCLUSION(S): The occurrence of a breakthrough LH surge despite GnRH-ant treatment is a reassuringly rare event. However, patients with diminished ovarian reserve are at risk for this outcome despite GnRH-ant down-regulation. Further studies are needed to determine whether these patients can be prospectively identified and whether they may benefit from higher doses of GnRH-ant.
Authors: Jun Zhang; Xingyu Zhou; Yingxue Chen; Qingyan Zhang; Ying Li; Jing Zhe; Xin Chen; Shiling Chen Journal: Nan Fang Yi Ke Da Xue Xue Bao Date: 2019-10-30
Authors: Reda S Hussein; Ihab Elnashar; Ahmed F Amin; Hisham A Abou-Taleb; Ahmed M Abbas; Ahmed M Abdelmageed; Tarek Farghaly; Yulian Zhao Journal: J Assist Reprod Genet Date: 2019-10-25 Impact factor: 3.412