This Article Full Text Full Text (PDF) Submit a related Letter to the Editor Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Copyright Permission Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Fauser, B. C. Articles by van Hooren, H. G. Search for Related Content PubMed PubMed Citation Articles by Fauser, B. C. Articles by van Hooren, H. G. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Hazardous Substances DB CHORIONIC GONADOTROPIN LEUPROLIDE

Endocrine Profiles after Triggering of Final Oocyte Maturation with GnRH Agonist after Cotreatment with the GnRH Antagonist Ganirelix during Ovarian Hyperstimulation for in Vitro Fertilization

Division of Reproductive Medicine, Erasmus Medical Center (B.C.F., D.d.J.), 3015 GD Rotterdam, The Netherlands; Hopital Antoine Beclere, Service de Gynecologie Obstetrique (F.O.), 405 Clamart, France; Karolinska Sjukhuset (H.W.), Kvinnokliniken, 17176 Stockholm, Sweden; Center for Reproductive Biology (C.T.), EH3 9EF Edinburgh, United Kingdom; Rambam Medical Center (J.I.E.), 31096 Haifa, Israel; and Clinical Development Department, NV Organon (H.G.v.H.), 5340 BH Oss, The Netherlands

Address all correspondence and requests for reprints to: Bart C. J. M. Fauser, M.D., Ph.D., Division of Reproductive Medicine, Erasmus Medical Center, Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands. E-mail: fauser{at}gyna.azr.nl

Abstract

In a randomized multicenter study, the efficacies of two different GnRH agonists were compared with that of hCG for triggering final stages of oocyte maturation after ovarian hyperstimulation for in vitro fertilization. Ovarian stimulation was conducted by recombinant FSH (Puregon), and the GnRH antagonist ganirelix (Orgalutran) was coadministered for the prevention of a premature LH rise. Luteal support was provided by daily progestin administration. Frequent blood sampling was performed at midcycle in the first 47 eligible subjects included in the current study, who were randomized for a single dose of 0.2 mg triptorelin (n = 17), 0.5 mg leuprorelin (n = 15), or 10,000 IU hCG (n = 15). Serum concentrations of LH, FSH, E2, and progesterone (P) were assessed at variable intervals.

LH peaked at 4 h after both triptorelin and leuprorelin administration, with median LH levels of 130 and 107 IU/liter (P < 0.001), respectively. LH levels returned to baseline after 24 h. Subjects receiving hCG showed peak levels of 240 IU/liter hCG 24 h after administration. A rise in FSH to 19 IU/liter (P < 0.001) was noted in both GnRH agonist groups 8 h after injection. Within 24 h the areas under the curve for LH and FSH were significantly higher (P < 0.001) in both GnRH agonist groups compared with that for hCG. E2 and P levels were similar for all groups up to the day of oocyte retrieval. Luteal phase areas under the curve for P and E2 were significantly elevated (P < 0.001) in the hCG group. The mean (±SD) numbers of oocytes retrieved were 9.8 ± 5.4, 8.7 ± 4.5, and 8.3 ± 3.3; the percentages of metaphase II oocytes were 72%, 85%, and 86%; and fertilization rates were 61%, 62%, and 56% in the triptorelin, leuprorelin, and hCG group, respectively (P = NS for all three comparisons). These findings support the effective induction of final oocyte maturation in both GnRH agonist groups.

In summary, after treatment with the GnRH antagonist ganirelix for the prevention of premature LH surges, triggering of final stages of oocyte maturation can be induced effectively by a single bolus injection of GnRH agonist, as demonstrated by the induced endogenous LH and FSH surge and the quality and fertilization rate of recovered oocytes. Moreover, corpus luteum formation is induced by GnRH agonists with luteal phase steroid levels closer to the physiological range compared with hCG. This more physiological approach for inducing oocyte maturation may represent a successful and safer alternative for in vitro fertilization patients undergoing ovarian hyperstimulation.

This article has been cited by other articles:

				G. Griesinger, S. von Otte, A. Schroer, A.K. Ludwig, K. Diedrich, S. Al-Hasani, and A. Schultze-Mosgau Elective cryopreservation of all pronuclear oocytes after GnRH agonist triggering of final oocyte maturation in patients at risk of developing OHSS: a prospective, observational proof-of-concept study Hum. Reprod., May 1, 2007; 22(5): 1348 - 1352. [Abstract] [Full Text] [PDF]

				R. L. Gustofson, J. H. Segars, and F. W. Larsen Ganirelix acetate causes a rapid reduction in estradiol levels without adversely affecting oocyte maturation in women pretreated with leuprolide acetate who are at risk of ovarian hyperstimulation syndrome Hum. Reprod., November 1, 2006; 21(11): 2830 - 2837. [Abstract] [Full Text] [PDF]

				C. Y. Andersen, P. Humaidan, H. B. Ejdrup, L. Bungum, M.L. Grondahl, and L.G. Westergaard Hormonal characteristics of follicular fluid from women receiving either GnRH agonist or hCG for ovulation induction Hum. Reprod., August 1, 2006; 21(8): 2126 - 2130. [Abstract] [Full Text] [PDF]

				B.C. Tarlatzis, B.C. Fauser, E.M. Kolibianakis, K. Diedrich, P. Devroey, and , On Behalf of the Brussels GnRH Antagonist Consen GnRH antagonists in ovarian stimulation for IVF Hum. Reprod. Update, July 1, 2006; 12(4): 333 - 340. [Abstract] [Full Text] [PDF]

				C. Pirard, J. Donnez, and E. Loumaye GnRH agonist as luteal phase support in assisted reproduction technique cycles: results of a pilot study Hum. Reprod., July 1, 2006; 21(7): 1894 - 1900. [Abstract] [Full Text] [PDF]

				S. Kol 'GnRH agonist trigger: looking for the coin under the lamp post?' Hum. Reprod., May 1, 2006; 21(5): 1328 - 1328. [Full Text] [PDF]

				S. Kol Agonist trigger in the context of OHSS prevention: primum non nocere Hum. Reprod. Update, May 1, 2006; 12(3): 327 - 328. [Full Text] [PDF]

				R. Babayof, E. J. Margalioth, M. Huleihel, A. Amash, E. Zylber-Haran, M. Gal, B. Brooks, T. Mimoni, and T. Eldar-Geva Serum inhibin A, VEGF and TNF{alpha} levels after triggering oocyte maturation with GnRH agonist compared with HCG in women with polycystic ovaries undergoing IVF treatment: a prospective randomized trial Hum. Reprod., May 1, 2006; 21(5): 1260 - 1265. [Abstract] [Full Text] [PDF]

				N. S. Macklon, R. L. Stouffer, L. C. Giudice, and B. C. J. M. Fauser The Science behind 25 Years of Ovarian Stimulation for in Vitro Fertilization Endocr. Rev., April 1, 2006; 27(2): 170 - 207. [Abstract] [Full Text] [PDF]

				G. Griesinger, K. Diedrich, P. Devroey, and E.M. Kolibianakis GnRH agonist for triggering final oocyte maturation in the GnRH antagonist ovarian hyperstimulation protocol: a systematic review and meta-analysis Hum. Reprod. Update, March 1, 2006; 12(2): 159 - 168. [Abstract] [Full Text] [PDF]

				P. Humaidan Reply: Luteal support post GnRH agonist trigger: do not stop too soon Hum. Reprod., November 1, 2005; 20(11): 3257 - 3258. [Full Text] [PDF]

				L. Engmann and C. Benadiva GnRH agonist (buserelin) or HCG for ovulation induction in GnRH antagonist IVF/ICSI cycles: a prospective randomized study Hum. Reprod., November 1, 2005; 20(11): 3258 - 3260. [Full Text] [PDF]

				E.M. Kolibianakis, A. Schultze-Mosgau, A. Schroer, A. van Steirteghem, P. Devroey, K. Diedrich, and G. Griesinger A lower ongoing pregnancy rate can be expected when GnRH agonist is used for triggering final oocyte maturation instead of HCG in patients undergoing IVF with GnRH antagonists Hum. Reprod., October 1, 2005; 20(10): 2887 - 2892. [Abstract] [Full Text] [PDF]

				C. Pirard, J. Donnez, and E. Loumaye GnRH agonist as novel luteal support: results of a randomized, parallel group, feasibility study using intranasal administration of buserelin Hum. Reprod., July 1, 2005; 20(7): 1798 - 1804. [Abstract] [Full Text] [PDF]

				P. Humaidan, H. Ejdrup Bredkjaer, L. Bungum, M. Bungum, M.L. Grondahl, L. Westergaard, and C. Yding Andersen GnRH agonist (buserelin) or hCG for ovulation induction in GnRH antagonist IVF/ICSI cycles: a prospective randomized study Hum. Reprod., May 1, 2005; 20(5): 1213 - 1220. [Abstract] [Full Text] [PDF]

				N. G. M. Beckers, N. S. Macklon, M. J. Eijkemans, M. Ludwig, R. E. Felberbaum, K. Diedrich, S. Bustion, E. Loumaye, and B. C. J. M. Fauser Nonsupplemented Luteal Phase Characteristics after the Administration of Recombinant Human Chorionic Gonadotropin, Recombinant Luteinizing Hormone, or Gonadotropin-Releasing Hormone (GnRH) Agonist to Induce Final Oocyte Maturation in in Vitro Fertilization Patients after Ovarian Stimulation with Recombinant Follicle-Stimulating Hormone and GnRH Antagonist Cotreatment J. Clin. Endocrinol. Metab., September 1, 2003; 88(9): 4186 - 4192. [Abstract] [Full Text] [PDF]