Induction of preovulatory luteinizing hormone surge and prevention of ovarian hyperstimulation syndrome by gonadotropin-releasing hormone agonist

Objective To use gonadotropin-releasing hormone agonist (GnRH-a) instead of human chorionic gonadotropin (hCG) to induce oocyte maturation for in vitro fertilization (IVF). Design Pituitary and ovarian responses to GnRH-a and the outcome of IVF were studied prospectively. Data from patients injected with hCG were analyzed retrospectively. Setting Program of IVF at the Rambam (Governmental) Hospital, Haifa, Israel. Patients and Interventions One or two doses of buserelin acetate 250 to 500 μ g were administered to six patients with moderate response (Estradiol [E 2 ], 1,494±422 [±SD] pg/mL) and 8 patients with exaggerated response (E 2 , 7,673±3,028 pg/mL) to gonadotropin stimulation. Progesterone (P) and E 2 were administered for luteal support. Main Outcome Measures Gonadotropin-releasing hormone agonist effectively triggered luteinizing hormone (LH)/follicle-stimulating hormone (FSH) surge. Mature oocytes were recovered in all patients. Luteal E 2 and P were lower than in patients injected with hCG. No signs of ovarian hyperstimulation syndrome were observed. Results Serum LH and FSH rose over 4 and 12 hours, respectively, and were significantly ( P Conclusions A bolus of GnRH-a is able to trigger an adequate midcycle LH/FSH surge, resulting in oocyte maturation and pregnancy. Our preliminary results also suggest that it allows a more accurate control of ovarian steroid levels during the luteal phase and may prevent the clinical manifestation of ovarian hyperstimulation syndrome