Endogenous luteinizing hormone is not increased during a GnRH-a microdose flare protocol.

Abstract

Objective: Microdose flare (MDF) stimulation protocols using GnRH agonist (GnRH-a) at 80 μg/d have been demonstrated to improve ART outcomes in poor responders. Higher dose GnRH-a (500μg/d) flare protocols have been associated with poor IVF outcomes in normal responders. It has been suggested that this was the result of elevated luteinizing hormone (LH) levels prior to hCG administration. LH levels have not been previously reported in normal responders using the MDF protocol. To determine whether LH levels were suppressed we examined LH levels in normal responders during a GnRH-a MDF protocol.Design: Cohort analysis of LH levels in patients undergoing ART using a GnRH-a MDF protocol in combination with follicle stimulation hormone (FSH) only.Materials/Methods: Patients aged 30–34, except those with chronic anovulation, undergoing an initial IVF cycle at our institution were started on a GnRH-a MDF protocol using FSH only. All patients starting in January 2001 were included. Patients were suppressed with oral contraceptives for at least 3 weeks prior to starting leuprolide acetate 40μg SQ BID on cycle day 3. FSH 150 IU q 12 hours was begun on cycle day 5. Both recombinant FSH and highly purified FSH were utilized. Blood samples collected for estradiol monitoring throughout stimulation were assayed for LH levels in batches. Intra-assay variation was 2%, inter-assay variation was 2.6%.Results: Mean patient age, days of stimulation, ampules of FSH, peak estradiol, and number of mature oocytes are shown in the table below. Forty percent of patients in this study group had a day 5 transfer. The mean LH value on the day of hCG administration was 2.3 mIU/mL. Data on LH level on the day of hCG was unavailable for one patient, however her level on the day prior to hCG administration was 2.0 mIU/mL. The pregnancy rate in this group exceeded 70%.Tabled 1Mean (range)Patient age (years)31.4 (30–33)Ampules used38.3 (32–44)Peak estradiol (pg/mL)5301.7 (1754–12618)Mature oocytes22.0 (2–40)LH on day of hCG (mIU/mL)2.3 (0.6–4.5) Open table in a new tab Conclusions: This study demonstrated that LH values are not elevated during a microdose flare protocol. Given the excellent pregnancy rates achieved, these data support the use of the microdose flare protocol in normal responders. Objective: Microdose flare (MDF) stimulation protocols using GnRH agonist (GnRH-a) at 80 μg/d have been demonstrated to improve ART outcomes in poor responders. Higher dose GnRH-a (500μg/d) flare protocols have been associated with poor IVF outcomes in normal responders. It has been suggested that this was the result of elevated luteinizing hormone (LH) levels prior to hCG administration. LH levels have not been previously reported in normal responders using the MDF protocol. To determine whether LH levels were suppressed we examined LH levels in normal responders during a GnRH-a MDF protocol. Design: Cohort analysis of LH levels in patients undergoing ART using a GnRH-a MDF protocol in combination with follicle stimulation hormone (FSH) only. Materials/Methods: Patients aged 30–34, except those with chronic anovulation, undergoing an initial IVF cycle at our institution were started on a GnRH-a MDF protocol using FSH only. All patients starting in January 2001 were included. Patients were suppressed with oral contraceptives for at least 3 weeks prior to starting leuprolide acetate 40μg SQ BID on cycle day 3. FSH 150 IU q 12 hours was begun on cycle day 5. Both recombinant FSH and highly purified FSH were utilized. Blood samples collected for estradiol monitoring throughout stimulation were assayed for LH levels in batches. Intra-assay variation was 2%, inter-assay variation was 2.6%. Results: Mean patient age, days of stimulation, ampules of FSH, peak estradiol, and number of mature oocytes are shown in the table below. Forty percent of patients in this study group had a day 5 transfer. The mean LH value on the day of hCG administration was 2.3 mIU/mL. Data on LH level on the day of hCG was unavailable for one patient, however her level on the day prior to hCG administration was 2.0 mIU/mL. The pregnancy rate in this group exceeded 70%. Tabled 1Mean (range)Patient age (years)31.4 (30–33)Ampules used38.3 (32–44)Peak estradiol (pg/mL)5301.7 (1754–12618)Mature oocytes22.0 (2–40)LH on day of hCG (mIU/mL)2.3 (0.6–4.5) Open table in a new tab Conclusions: This study demonstrated that LH values are not elevated during a microdose flare protocol. Given the excellent pregnancy rates achieved, these data support the use of the microdose flare protocol in normal responders.