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[LH and GnRH antagonists]
1Service de gynécologie obstétrique, Hôpital Antoine-Béclère, Clamart.
Abstract:
New GnRH antagonists are available in clinical practice. The different studies have confirmed the efficacy of these antagonists in preventing the LH surge. Two protocols have been described: in the multiple dose regimens, small doses of antagonist (0.25 mg) are injected starting on stimulation day 5 or 6 until hCG. In the single dose protocol, one injection of a larger dose (3 mg) is proposed in the late follicular phase. The remaining levels of endogenous LH appears to be sufficient in the multiple doses protocol. In the single an estradiol drop is observed in some patient following the 3 mg injection of Cetrorelix. This drop is related to the LH decrease. Its adverse effect on IVF results is not demonstrated.
Insights
New gonadotropin-releasing hormone (GnRH) antagonists effectively prevent the LH surge in clinical practice. Both multiple and single-dose protocols demonstrate efficacy, with minimal impact on IVF outcomes despite minor estradiol fluctuations.
Area of Science:
- Reproductive Endocrinology
- In Vitro Fertilization (IVF)
Background:
- Gonadotropin-releasing hormone (GnRH) antagonists are now clinically available.
- These agents are crucial for preventing the premature luteinizing hormone (LH) surge during controlled ovarian stimulation.
Purpose of the Study:
- To review the efficacy and protocols of GnRH antagonists in preventing the LH surge.
- To assess the impact of different dosing regimens on hormonal levels and IVF outcomes.
Main Methods:
- Description of two primary GnRH antagonist administration protocols: multiple dose regimens and a single dose protocol.
- Analysis of studies confirming the efficacy of these antagonists in preventing the LH surge.
Main Results:
- Multiple dose regimens (0.25 mg daily from day 5/6) maintain sufficient endogenous LH levels.
- A single dose protocol (3 mg) in the late follicular phase can cause a transient estradiol drop related to LH decrease, but without demonstrated adverse effects on IVF results.
Conclusions:
- GnRH antagonists offer effective LH surge prevention in IVF protocols.
- Both multiple and single-dose regimens are viable, with the single 3 mg dose showing no proven negative impact on IVF success despite transient hormonal changes.