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Human Reproduction, Vol. 9, No. 2, pp. 235-240, 1994
© 1994 European Society of Human Reproduction and Embryology

other

Early follicular rise of serum progesterone concentration in response to a flare-up effect of gonadotrophin-releasing hormone agonist impairs follicular recruitment for in-vitro fertilization

J.A. Sims, H.J. Seltman and S.J. Muasher1

The Jones Institute for Reproductive Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School Norfolk, VA 23507, USA

Correspondence: 1To whom correspondence should be addressed

A retrospective study of 150 cycles of in-vitro fertilization (IVF) was undertaken to determine the impact of elevated serum progesterone in the early follicular phase of IVF cycles utilizing gonadotrophin-releasing hormone agonist (GnRHa) initiated in the follicular phase. A total of 127 patients identified as being at risk for poor response to stimulation were treated with a flare-up protocol of GnRHa combined with high dose follicle stimulating hormone (FSH). Patients were excluded for severe male factor requiring micromanipulation. Patients were stimulated with GnRHa beginning on cycle day 2, and high dose FSH beginning on cycle day 3. Some 85% of the cycles exhibited a rise of serum progesterone to a peak concentration of > 1.0 ng/ml (range, 1.2–4.2 ng/ml) during cycle days 2–6. When compared to cycles with no demonstrable progesterone rise, cycles with a rise were associated with a significantly decreased ovarian response: more ampoules of gonadotrophin were required (mean 26.8 versus 22.6, P < 0.05), lower peak oestradiol concentration was reached (mean 774 pg/ml versus 1030; P < 0.05), and fewer mature oocytes were harvested (mean 4.6 versus 7.5; P < 0.01). Among the different pregnancy outcomes (clinical pregnancy, no pregnancy, ongoing pregnancy, and miscarrige), there were no significant differences detected in the early follicular progesterone concentrations as measured by peak progesterone, progesterone area undre the curve (days 2–6), and day of peak progesterone. The follicular phase initiation of GnRHas can result in significant elevations of serum progesterone in the early follicular phase, which may impair follicular recruitment and overall ovarian response.

Key words: falre protocol/follicular phase/gonadotrophin-releasing hormone agonist/in-vitro fertilization–embryo transfer/serum progesterone


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E.M. Kolibianakis, K. Zikopoulos, J. Smitz, M. Camus, H. Tournaye, A.C. Van Steirteghem, and P. Devroey
Elevated progesterone at initiation of stimulation is associated with a lower ongoing pregnancy rate after IVF using GnRH antagonists
Hum. Reprod., July 1, 2004; 19(7): 1525 - 1529.
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