Selective use of leuprolide acetate in women undergoing superovulation with intrauterine insemination results in significant improvement in pregnancy outcome.

OBJECTIVE: To examine the incidence of premature luteinization in individuals undergoing hMG with IUI therapy, the association between premature luteinization, cycle fecundity, and pregnancy outcome, and to determine if the selective use of leuprolide acetate (LA) in women demonstrating premature luteinization improves pregnancy outcome in subsequent hMG with IUI cycles. DESIGN AND SETTING: Retrospective analysis of superovulation cycles from January 1990 until December 1991 at the University of Connecticut Health Center. PATIENTS: All women with ovulatory function undergoing hMG superovulation with IUI. INTERVENTIONS: All patients were tested for evidence of premature luteinization. Those demonstrating premature luteinization were started on LA in the luteal phase in their subsequent hMG with IUI cycle. MAIN OUTCOME MEASURES: Peak serum E2, the number of mature preovulatory follicles, the number of ampules of hMG, days of hMG therapy, cycle fecundity, and spontaneous abortion rate. RESULTS: Thirty-three percent of all hMG with IUI patients showed evidence of premature luteinization, with premature luteinization occurring in 22.2% of conception cycles and 37.4% of nonconception cycles. For those women who demonstrated premature luteinization in their conception cycle, 90.0% of the pregnancies ended with either spontaneous abortion or were biochemical in nature compared with 44.3% in the cycles without evidence of premature luteinization. Cycle fecundity was 11.1% in patients demonstrating premature luteinization compared with 26.3% for patients without premature luteinization. All women demonstrating premature luteinization and not conceiving were placed on LA in the luteal phase and had a subsequent cycle fecundity of 18.9% with the percent pregnancy wastage being significantly less (33.3% versus 90.0%) when LA was used. CONCLUSIONS: Premature luteinization is a common occurrence during hMG therapy and is associated with decreased cycle fecundity and an increased incidence of spontaneous abortion and biochemical pregnancies. The selective use of LA in those individuals demonstrating premature luteinization results in a significant increase in the percent of women conceiving a viable pregnancy.

The anabolic effects of progesterone on fetal rat calvaria in tissue culture.

OBJECTIVE: We examined the effects of progesterone and cortisol on [3H] thymidine incorporation into DNA, total DNA content, and [3H] proline incorporation into collagen using a bone organ culture system. METHODS: The study consisted of nine experiments conducted at the University of Connecticut after approval by the animal care committee. Fetal rat half calvaria were cultured in the presence of progesterone (10(-5) to 10(-15) mol/L) and/or cortisol (10(-7) mol/L). Statistical analysis was carried out by analysis of variance. RESULTS: There was a biphasic increase in [3H] thymidine incorporation and DNA content of the tissue sample with progesterone treatment, with peaks at both high and low concentrations. Significant increases in [3H] proline incorporation were noted at concentrations of 10(-6) to 10(-10) mol/L of progesterone. Similar responses were observed in the presence of cortisol. CONCLUSIONS: Progesterone increased [3H] thymidine incorporation into DNA, total DNA content, and [3H] proline incorporation into collagen proteins in cultured fetal rat calvaria over a wide range of progesterone concentrations in the presence and absence of cortisol.

The value of increasing the dose of human menopausal gonadotropins in women who initially demonstrate a poor response.

OBJECTIVE: To evaluate the benefit of increasing the hMG dose in subsequent superovulation cycles for those individuals who demonstrate a poor response on up to three ampules of hMG daily. DESIGN AND SETTING: Retrospective analysis of all superovulation cycles at the University of Connecticut Health Center. PATIENTS: All women undergoing hMG therapy with IUI from January 1990 until December 1992. INTERVENTIONS: All patients were initially stimulated with up to three ampules of hMG daily. All patients who did not conceive on their first hMG cycle and demonstrated a poor response to hMG therapy were started on higher doses of hMG in an effort to obtain a good response. A maximum of eight ampules of hMG per day were used. MAIN OUTCOME MEASURES: Peak serum E2, the number of mature preovulatory follicles, and cycle fecundity were compared. RESULTS: The poor responders using up to three ampules daily had a peak E2 of 384 +/- 26 pg/mL (1,421 +/- 96 pmol/L), 1.4 +/- 0.1 mature follicles, and a cycle fecundity of 3.1% compared with an E2 of 900 +/- 83 pg/mL (3,330 +/- 307 pmol/L), 2.7 +/- 0.2 mature follicles, and a cycle fecundity of 4.3% when these poor responders had their dose increased to five or more ampules daily. Those individuals demonstrating a good response on less than or equal to three ampules of hMG daily had an average peak E2 of 1,159 +/- 41 pg/mL (4,288 +/- 151 pmol/L), 3.4 +/- 0.2 mature follicles, and a cycle fecundity of 16.5%. CONCLUSIONS: Despite significant improvement in peak E2 and the number of mature preovulatory follicles when the hMG dose was increased in poor responders, no significant increase in cycle fecundity was noted.