Letter to the editor |
Reply: GnRH agonist (buserelin) or hCG for ovulation induction in gnRH antagonist IVF/ICSI cycles: a prospective randomized study
The Fertility Clinic, Viborg Hospital (Skive), Resenvej 25, DK-7800 Skive, Denmark
E-mail: peter.humaidan{at}sygehusviborg.dk
Sir,
Thank you for giving me the opportunity to respond to Doctors Engmann and Benadiva. First of all, the question concerning the length of the luteal support with progesterone and estradiol after triggering of final oocyte maturation in IVF/ICSI cycles with a GnRH agonist reported in our study (Humaidan et al., 2005
) has been thoroughly debated in my answer to Dr Kol (Humaidan, 2005).
Engmann and Benadiva raise a question concerning the route of administration of progesterone. In our study (Humaidan et al., 2005), patients received luteal phase supplementation in the form of micronized progesterone vaginally, 90 mg a day and estradiol, 4 mg a day per os administered from the day following oocyte aspiration and continuing until the day of the pregnancy test, i.e. a total of 13–14 days. Engmann and Benadiva claim, from their clinical experience, that the i.m. route may be preferable as compared to the vaginal route when a GnRH agonist is used to trigger final oocyte maturation in IVF/ICSI cycles. The route of luteal phase support has been focused upon in several clinical trials.
Miles et al. (1994), in a study comparing the i.m. route with vaginally administered micronized progesterone, found that tissue levels of progesterone were significantly higher after vaginal administration compared with the i.m. administration, despite lower serum progesterone levels after vaginal administration. Devroey et al. (1989), in a study comparing the oral, vaginal and i.m. route, found that normal synchronous endometrial development occurred only after vaginal administration, rather than i.m. or oral administration, despite the fact that serum levels of progesterone were comparable with those obtained after oral administration. Moreover, Penzias (2002), reporting the results of a consensus meeting, concluded that pregnancy rates after vaginal and i.m. progesterone administration are comparable, despite higher serum progesterone levels after i.m. administration.
Finally, in the study by Griesinger et al. (2004), which confirms our results, vaginal and i.m. progesterone was administered as a luteal phase support until 7 weeks of pregnancy in one of the two centres participating in the study.
In conclusion, two prospective randomized trials including 122 patients (Humaidan et al., 2005) and 106 patients (Griesinger et al., 2004), respectively, have reported similarly poor clinical results when final oocyte maturation was triggered with a GnRH agonist, regardless of the length and type of luteal support used.
References
Devroey P, Palermo G, Bourgain C, van Waesberghe L, Smitz J and Van Steirteghem AC (1989) Progesterone administration in patients with absent ovaries. Int J Fertil 34, 188–193.[ISI][Medline]
Griesinger G, Schultze-Mosgau A, Schroer A, van Steirteghem A, Devroey P, Diedrich K and Kolibianakis E (2005) GnRH-agonist instead of hCG for final oocyte maturation in GnRH-antagonist cycles. Hum Reprod 20, (Supp 1), i92,0–247.
Humaidan P (2005) GnRH agonist instead of hCG for final ooyte maturation in GnRH antagonist cycles. Letter to the Editor. Hum Reprod 20, 000.
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.
Miles RA, Paulson JP, Lobo RA, Press MF, Damoush L and Sauer M (1994) Pharmacokinetics and endometrial tissue levels of progesterone after administration by intramuscular and vaginal routes: a comparative study. Fertil Steril 62, 485–490.[ISI][Medline]
Penzias AS (2002) Luteal phase support. Fertil Steril 77, 318–323.[CrossRef][ISI][Medline]
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