Serum and follicular fluid hormone levels during in vitro fertilization after short- or long-course treatment with a gonadotropin-releasing hormone agonist

Abstract

Objective: To examine the impact of flare (short) vs. down-regulation (long) GnRH agonist (GnRH-a) on serum and follicular fluid (FF) LH and androgen concentrations in women undergoing IVF treatment cycles. Design: Prospective observational study. Setting: IVF clinic. Patient(s): One hundred sixteen ovulatory subjects undergoing IVF. Intervention(s): Fifty-eight ovulatory patients undergoing a down-regulation regimen matched with 58 undergoing the flare regimen as part of an IVF cycle. Main Outcome Measure(s): Serum concentrations of LH, FSH, Progesterone (P4), Androstenedione (A), T, and E 2 on the day of hCG administration were compared between the two groups. In addition, the FF P4, 17OHP4, A, T, and E 2 levels were compared in the two groups. Result(s): Serum LH was significantly higher with the flare regimen (15.2 ± 1.14 IU/L, P<.05) when compared with results with the down-regulation protocol (9.5 ± 0.77 IU/L). In addition, FF A was significantly higher in the flare protocol (57.3 ± 13.3 ng/mL, P<.05) compared with in the down-regulation protocol (27 ± 2.44 ng/mL). Serum and FF P4, 17OH P4, T, and E 2 were not statistically significantly different between the two groups. Conclusion(s): Serum LH and FF A are significantly higher in the flare regimen in comparison with the down-regulation regimen. Circulating LH appears to play a role in determining FF A concentration.