Premature luteinization in GnRH-antagonist cycles in patients with Polycystic Ovarian Syndrome and IVF outcome

Abstract

To determine the incidence of premature luteinization in patients with Polycystic Ovarian Syndrome (PCOS) using GnRH-Antagonist protocol in IVF cycles and correlation with outcome. Retrospective case control study. Twenty two patients diagnosed with PCOS with a prior unsuccessful IVF cycle using a GnRH-Agonist protocol underwent controlled ovarian hyperstimulation with GnRH-Antagonist between 03/2002 and 12/2003. Premature luteinization was defined as a progesterone level >1.3 ng/ml on day of hCG. Data collected included: age, peak estradiol, and progesterone and LH levels on the day of hCG. In addition, number of eggs retrieved, number of embryos developed, embryos transferred, embryos frozen, implantation rate and pregnancy rate were recorded. Statistical analysis was performed using ANOVA and Chi square methodology. The incidence of premature luteinization was 50% in patients with PCOS who used a GnRH-Antagonist protocol for IVF. Implantation rate (36.36% vs 22.73%, p=0.03), and pregnancy rate (73% vs 18%, p=<0.0001) were significantly higher in PCOS patients without premature luteinization. Implantation and pregnancy rates were significantly greater in PCOS patients without evidence of premature luteinization when using a GnRH-Antagonist protocol. The occurrence of premature luteinization occurs frequently, and if it occurs has a negative effect on pregnancy rate.