Purpose
This study compares the results of three ovulation induction protocols in polycystic ovarian disease (PCOD) patients undergoing an in vitro fertilizationembryo transfer (IVF-ET) program. A total of 85 cycles was studied. The patients were treated with clomiphene citrate (CC) plus human menopausal gonadotropin (hMG) (CC/hMG group), with purified menofollitropin (pFSH) plus hMG (pFSH/hMG group), and with pFSH/hMG plus gonadotropin releasing hormone analogue (GnRH-a) (analogue group). In the analogue group the suppression of luteinizing hormone (LH) with GnRH-a decreased the number of follicles <12 mm on the day of human chorionic gonadotropin (hCG) administration and the number and percentage of immature oocytes retrieved and increased the percentage of mature oocytes retrieved.
Results
However, fertilization rates of oocytes, cleaved embryo rates, pregnancy rates following replacement, and pregnancy outcomes were not different.
Conclusion
Although the suppression of the hypothalamic-pituitary-ovarian axis with GnRH-a in PCOD patients improved follicular synchrony and oocyte maturity, none of the ovulation induction protocols was superior to the others with respect to pregnancy rates and pregnancy outcomes.
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References
Speroff L, Glass RH, Kase NG: Clinical Gynecologic Endocrinology and Infertility, ed. 4. Baltimore, Williams and Wilkins, 1989
Baird DT, Corker CS, Davidson DW, Hunter WM, Michie EA, Vanlook PFA: Pituitary-ovarian relationships in polycystic ovary syndrome. J Clin Endocrinol Metab 1977;45:798–809
Dor J, Itzkowic DJ, Mashiach S, Lunenfeld B, Serr DM: Cumulative conception rates following gonadotropin therapy. Am J Obstet Gynecol 1980;136:102–105
Hammond MG, Halme JK, Talbert LM: Factors affecting the pregnancy rate in clomiphene citrate induction of ovulation. Obstet Gynecol 1983;62:196–202
Venturini PL, Remorgida V, Anserini P, De Cocco L: Use of combined exogenous gonadotropins and pulsatile gonadotropin-releasing hormone in patients with polycystic ovarian disease: A new approach to induction of ovulation. Gynecol Endocrinol 1988;2:205–212
Eshel A, Abdulwahid NA, Armar NA, Adams JM, Jacobs HS: Pulsatile luteinizing hormone-releasing hormone therapy in women with polycystic ovary syndrome. Fertil Steril 1988;49:956–960
Wang CF, Gemzell G: The use of human gonadotropins for the induction of ovulation in women with polycystic ovarian disease. Fertil Steril 1980;33:479–486
Fleming R, Adam AH, Barlow DH, Black WP, Macnaughton MC, Coutts JRT: A new systematic treatment for infertile women with abnormal hormone profiles. Br J Obstet Gynaecol 1982;89:80–83
Garcea N, Campo S, Panetta V, Venneri M, Siccardi P, Dargenio R, De Tomasi F: Induction of ovulation with purified urinary follicle stimulating hormone in patient with polycystic ovarian syndrome. Am J Obstet Gynecol 1985;151:635–640
Filicori M, Campaniello E, Michelacci L, Pareschi A, Ferrari P, Bolelli G, Flamigni C: Gonadotropin-releasing hormone (GnRH) analog suppression renders polycystic ovarian disease patients more susceptible to ovulation induction with pulsatile GnRH. J Clin Endocrinol Metab 1988;66:327–333
Fleming R, Haxton MJ, Hamilton MPR, McCune GS, Black WP, Macnaughton MC, Coutts JRT: Successful treatment of infertile women with oligomenorrhoea using a combination of an LHRH agonist and exogenous gonadotropins. Br J Obstet Gynaecol 1985;92:369–373
Homburg R, Eshel A, Kilborn J, Adams J, Jacobs HS: Combined luteinizing hormone releasing hormone analogue and exogenous gonadotropins for the treatment of infertility associated with polycystic ovaries. Hum Reprod 1990;5:32–35
Adams J, Polson DW, Abdulwahid N, Morris DV, Franks S, Mason HD, Tucker M, Price J, Jacobs HS: Multifollicular ovaries: Clinical and endocrine features and response to pulsatile gonadotropin releasing hormone. Lancet 1985;2:1375–1378
Acosta AA, Jones GS, Garcia JE, Sandow B, Veeck L, Mantzavinos T: Correlation of human menopausal gonadotropin/human chorionic gonadotropin stimulation and oocyte quality in an in vitro fertilization program. Fertil Steril 1984;41:196–201
Dor J, Rudak E, Mashiach S, Nebel L, Serr DM and Goldman B: Periovulatory 17β-estradiol changes and embryo morphologic features in conception and nonconceptional cycles after human in vitro fertilization. Fertil Steril 1986;45:63–66
Salat-Baroux J, Alvarez S, Antoine JM, Cornet D, Tibi Ch, Plachot M, Mandelbaum J: Results of IVF in the treatment of polycystic ovary disease. Hum Reprod 1988;3:331–335
Ashkenazi J, Feldberg D, Dicker D, Yeshaya A, Ayalon D, Goldman JA: IVF-ET in women with refractory polycystic ovarian disease. Eur J Obstet Gynecol Reprod Biol 1989;30;157–161
Dodson WC, Hughes CL, Whitesides DB, Haney AF: The effect of leuprolide acetate on ovulation induction with human menopausal gonadotropins in polycystic ovary syndrome. J Clin Endocrinol Metab 1987;65:95–100
Charbonnel B, Krempf M, Blanchard P, Dano F, Delage C: Induction of ovulation in polycystic ovary syndrome with a combination of a luteinizing hormone-releasing hormone analog and exogenous gonadotropins. Fertil Steril 1987;47:920–924
Fleming R, Hamilton MPR, Conaghan C, Black WP, Coutts JRT: Ovarian sensitivity to gonadotropins in patients with PCO is unaffected by suppression of LH. Clin Endocrinol 1990;32:33–38
Lanzone A, Fulghesu AM, Spina MA, Apa R, Menini E, Caruso A, Mancuso S: Successful induction of ovulation and conception with combined gonadotropin-releasing hormone agonist plus highly purified follicle-stimulating hormone in patients with polycystic ovarian disease. J Clin Endocrinol Metab 1987;65:1253–1258
Homburg R, Armar NA, Eshel A, Adams J, Jacobs HS: Influence of serum luteinizing hormone concentrations on ovulation, conception, and early pregnancy loss of polycystic ovary syndrome. Br Med J 1988;297:1024–1026
Stanger JD, Yovich JL: Reduced in vitro fertilization of human oocytes from patients with raised basal luteinizing hormone levels during the follicular phase. Br J Obstet Gynaecol 1985;92:385–393
Dodson WC, Myers T, Morton PC, Conn PM: Leuprolide acetate: serum and follicular fluid concentrations and effects on human fertilization, embryo growth, and granulosa-lutein cell progesterone accumulation in vitro. Fertil Steril 1988;50:612–617
Testart J, Belaisch-Allart J, Forman R, Gazengel A, Strubb N, Hazout A, Frydman R: Influence of different stimulation treatments on oocyte characteristics and in vitro fertilizing ability. Hum Reprod 1989;4:192–197
Hill GA, Freeman M, Bastias MC, Rogers BJ, Herbert III CM, Osteen KG, Wentz AC: The influence of oocyte maturity and embryo quality on pregnancy rate in a program for in vitro fertilization-embryo transfer. Fertil Steril 1989;52:801–806
Jones HW, Acosta AA, Andrews MC, Garcia JE, Jones GS, Mayer J, McDowell JS, Rosenwaks Z, Sandow BA, Veeck LL, Wilkes CA: Three years of in vitro fertilization at Norfolk. Fertil Steril 1984;42:826–834
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Turhan, N.Ö., Artini, P.G., D'Ambrogio, G. et al. A comparative study of three ovulation induction protocols in polycystic ovarian disease patients in an in vitro fertilization/embryo transfer program. J Assist Reprod Genet 10, 15–20 (1993). https://doi.org/10.1007/BF01204435
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DOI: https://doi.org/10.1007/BF01204435