Progesterone/estradiol ratio in the late follicular phase of long gonadotropin-releasing hormone agonist cycles did not differ between conceived and not-conceived women

There is a challenging debate on the effect of premature luteinization on the clinical outcome of 'controlled ovarian hyperstimulation' [COH] using long 'gonadotropin-releasing hormone agonist' [GnRHa] cycles. Premature luteinization is defined as late follicular progesterone/estradiol ratio more than 1 on the day of human chorionic gonadotropin [HCG] administration. We carried out a retrospective case-control study on 75 conceived cases versus 75 not-conceived control women, receiving long GnRHa cycles in their first cycle of treatment. Premature luteinization developed in 15% of the case group vs. 22% of the control group. Neither the late follicular progesterone/estradiol [P/E2] ratio was significantly different between the two groups, nor the day 3 follicle stimulating hormone [FSH], serum estradiol level on the HCG day, total amount of human menopausal gonadotropins ampoules, number of follicles, retrieved oocytes and transferred embryos. Endometrial thickness was significantly more in the pregnant women than in the non-pregnant group. Premature luteinization seems not to adversely affect the clinical outcome of COH

Half-dose depot triptorelin comparable to reduced daily buserelin: a randomized clinical trial

Pituitary suppression by depot GnRH agonist may be excessive for ovarian stimulation. This study compares the efficacy of a single half-dose depot triptorelin and reduced-dose daily buserelin in a long protocol ICSI/ET. A total of 182 patients were randomized into two groups using sealed envelopes. Pituitary desensitization was obtained in group 1 [91 patients] with half-dose [1.87 mg] depot triptorelin in the mid-luteal phase of their menstrual cycle, and in group 2 [91 patients] with standard daily dose [0.5 mg] buserelin, which was then reduced to 0.25 mg at the start of human menopausal gonadotropin [HMG] stimulation. No significant differences were found among those who received HCG in terms of clinical pregnancy rate [34.4% in both groups], implantation rate [14.8% in group 1 versus 11.1% in group 2], fertilization rate [93.3 versus 95.6%], poor response rate [11.1 versus 6.7%], and miscarriage rate [11.1 versus 7.8%]. No significant differences were seen in number of HMG ampoules used, follicles at HCG administration, and oocytes retrieved. The number of days of stimulation was significantly reduced in group 2 [11.2 +/- 1.8 in group 1 versus 10.6 +/- 1.9, P = 0.030]. A half-dose of depot triptorelin can be successfully used in ovarian stimulation instead of reduced-dose daily buserelin, with more patient comfort and reduced stress and cost of injections