Response: Single dose GnRH agonist administration in the luteal phase of assisted reproduction cycles: is the effect dependent on the type of GnRH analogue used for pituitary suppression?

Abstract

We read the comments by Ata and Urman, 2009Ata B. Urman B. Single dose GnRH agonist administration in the luteal phase of assisted reproduction cycles: is the effect dependent on the type of GnRH analogue used for pituitary suppression? Reprod.BioMed. Online. 2009; 20: 165-166Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar relating to our article with great interest. The target of our study was the luteal phase management in antagonist-administered ovarian stimulation cycles. When the study by Ata et al., 2008Ata B. Yakin K. Balaban B. et al.GnRH agonist protocol administration in the luteal phase in ICSI-ET cycles stimulated with the long GnRH agonist protocol: a randomized, controlled double blind study.Hum. Reprod. 2008; 23: 668-673Crossref PubMed Scopus (43) Google Scholar and ours (Isik et al., 2009Isik A.Z. Caglar G.S. Sozen E. et al.Single-dose GnRH agonist administration in the luteal phase of GnRH antagonist cycles: a prospective randomized study.Reprod. BioMed. Online. 2009; 19: 472-477Abstract Full Text Full Text PDF PubMed Scopus (43) Google Scholar) are compared it can be seen that the luteal phases were managed differently. We administered 1500 IU HCG intramuscularly once in addition to intravaginal micronized progesterone 600 mg daily. On the other hand Ata et al., 2008Ata B. Yakin K. Balaban B. et al.GnRH agonist protocol administration in the luteal phase in ICSI-ET cycles stimulated with the long GnRH agonist protocol: a randomized, controlled double blind study.Hum. Reprod. 2008; 23: 668-673Crossref PubMed Scopus (43) Google Scholar only used 90 mg vaginal progesterone gel in their study. Moreover, the doses and types of agonists used for the luteal support were different. For that reason the meta-analysis conducted by Ata and Urman, 2009Ata B. Urman B. Single dose GnRH agonist administration in the luteal phase of assisted reproduction cycles: is the effect dependent on the type of GnRH analogue used for pituitary suppression? Reprod.BioMed. Online. 2009; 20: 165-166Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar may not be valid. In addition to this we have been conducting a new controlled randomized trial comparing the effectiveness of single and multi-dose agonist administration in the luteal phase of ovarian stimulation cycles. During this study period a case has proved the effectiveness of agonist administration as a luteal support. A 36-year old poor-responder patient who had yielded four mature oocytes after antagonist stimulation inadvertently did not use progesterone and HCG support. Instead she only used the multi-dose agonist for luteal phase support and she became pregnant and this pregnancy is ongoing now. In conclusion, at present it cannot be stated whether luteal phase agonist administration in antagonist COH cycles is effective or not. There is an absolute need for future multi-centre trials to clarify this issue and we hope that these may eventually lead to another tool for luteal phase management.