Effective downregulation for in vitro fertilization with a one-time, one-third dose of depot formulation of leuprolide acetate intramuscularly in the luteal phase

Abstract

One-third dose (1.25 mg) of depot formulation of leuprolide acetate (LA) was used to provide steady-state downregulation for controlled ovarian hyperstimulation with recombinant FSH for in vitro fertilization (IVF). Pituitary suppression (downregulation) for IVF is commonly accomplished using daily dosing of subcutaneous leuprolide acetate (0.5 mg). We sought to compare the efficacy of a single, one-third IM dose of LA depot (1.25 mg) with daily dose LA (0.5 ne-timemg) for pituitary downregulation prior to controlled ovarian hyperstimulation for IVF. A single center, nonrandomized clinical observation study. Down-regulation data from thirty women undergoing controlled ovarian hyperstimulation were examined for this trial. The patients ranged in age from 24 to 39 years. Body mass index ranged from 16 to 39. Women were given a one-third dose of LA depot (1.25 mg) intramuscularly 10 days after a positive LH surge. Serum baseline levels of FSH, LH, progesterone and estradiol were obtained on day three of patients' menstrual cycles prior to administration of LA depot. Two weeks after LA depot IM injection, FSH, LH, progesterone and estradiol levels were once again obtained. Prior to HCG injections (following about 10 to 12 days of recombinant FSH stimulation) LH, and progesterone levels were obtained. One-third dose LA depot formulation appeared to provided satisfactory pituitary suppression of LH (<5 IU/L), and FSH prior to controlled ovarian hyperstimulation when compared to circulating concentrations of LH and FSH drawn prior to initiation of suppression (P < .05). As expected, steroid hormones were also suppressed (P < .001). The downregulation of LH continued throughout the period of hyperstimulation with rFSH (P < .05) and there was no evidence of premature release of luteinizing hormone prior to oocyte aspiration. A small increase in progesterone was observed just prior to hCG adminstration (P < .05). However, progesterone levels never exceeded 2 ng/mL prior to retrieval. In this small patient population, one-third dose of LA depot appeared to have the same efficacy as daily LA injections with regards to pituitary downregulation and clinical outcomes. Patient ease in one-time dosing would be a preferred advantage of this technique compared to daily dosing. A controlled trial is needed to conclusively establish the efficacy of this treatment.