Human Reproduction, Vol. 16, No. 9, 2030,
September 2001
© 2001 European Society of Human Reproduction and Embryology
Letters to the editor |
Women with small ovarian volume and microdose GnRH agonist protocol
Assisted Conception Unit, Birmingham women's Hospital, Edgbaston Birmingham B15 2TG, UK
Dear Sir,
We read with interest the paper on the effect of higher dose gonadotrophin, microdose gonadotrophin-releasing hormone (GnRH) agonist stimulation in women with a small ovarian volume noted at baseline ultrasound (Sharara and McClamrock, 2001). We agree with the authors that it is a quick test to recognize the poor responder before starting ovarian stimulation. However there are a few issues that need to be further addressed.
It was not clear if the ovarian volume measurements were performed by the same investigator in all patients. If there were more than one investigator it would be useful to know the inter-observer variability of the sonographic measurements of ovarian volume (Altman et al., 1983).
The main reason for non-randomization of patients in this study, as stated by the authors, was to avoid the sub-optimal outcome associated with a standard long protocol. In support of this, the authors referred to previously published data. However, we do not agree that these supporting data are so conclusive to date, mainly because of their heterogeneity. For example in the study by Syrop et al. infertile women with polycystic ovarian disease (PCO) were included (Syrop et al., 1995
), and in contrast patients with typical appearance of PCO on ultrasound scan were excluded from another study (Lass et al., 1997). This paper does suggest a benefit from using an aggressive ovarian stimulation regimen in the patients with small ovarian volume. However, the definitive proof can only be obtained by randomized controlled trials.
Notes
1 To whom correspondence should be addressed. E-mail: nahed.hammadieh{at}bham-womens.thenhs.com 
References
Altman, G.D. and Bland, M.J. (1983) Measurement in Medicine: the analysis of method comparison studies. The Statistician, 32, 307–317.
Lass, A., Skull, J., McVeigh, E. et al. (1997) Measurement of ovarian volume by transvaginal sonography before ovulation induction with human menopausal gonadotrophin for in-vitro fertilization can predict poor response. Hum. Reprod., 12, 294–297.
Sharara, Fady I. and McClamorock, D.H. (2001) Use of microdose GnRH agonist protocol in women with low ovarian volumes undergoing IVF. Hum. Reprod., 16, 500–503.
Syrop, C.H., Wilhoite, A. and Van-Voorhis, B.J. (1995) Ovarian volume: a novel outcome predictor for assisted reproduction. Fertil. Steril., 64, 1167–1171.[Web of Science][Medline]
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