Letter to the editor |
Luteal support post GnRH agonist trigger: do not stop too soon
IVF Unit, Rambam Medical Center, Haifa 31096, Israel
E-mail: skol{at}rambam.health.gov.il
Sir,
Humaidan et al. (2005)
compared GnRH agonist (buserelin) and hCG triggers in a GnRH antagonist-based protocol. Luteal support was given for 12 days starting on the day following oocyte retrieval and stopping on the day of pregnancy test. The GnRH agonist group suffered a 79% early pregnancy loss.
Although recruitment for this study was complete by February 2004, recent studies have shown that triggering ovulation with a GnRH agonist causes complete luteolysis (Nevo et al., 2003), with the implication that luteal support is needed until week 9 of pregnancy (
2 weeks post luteal-placental shift). Without such support, a high rate of early pregnancy loss is inevitable.
References
Humaidan P, Ejdrup Bredkjaer H, Bungum L, Bungum M, Grondahl ML, Westergaard L and Yding Andersen C (2005) GnRH agonist (buserelin) or hCG for ovulation induction in GnRH antagonist IVF/ICSI cycles: a prospective randomized study. Hum Reprod 20,1213–1220.
Nevo O, Eldar-Geva T, Kol S and Itskovitz-Eldor J (2003) Lower levels of inhibin A and pro-alphaC during the luteal phase after triggering oocyte maturation with a gonadotropin-releasing hormone agonist versus human chorionic gonadotropin. Fertil Steril 79,1123–1128.[CrossRef][ISI][Medline]
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