GnRH antagonist ganirelix prevents premature luteinization in IUI cycles: rationale for its use
J Martinez-Salazar1, M Cerrillo, G Quea
1IVI-Madrid, Spain.
Abstract:
This study evaluated the efficacy of a gonadotrophin-releasing hormone antagonist (GnRHa) to prevent premature luteinization (PL) and examined its impact on intrauterine insemination (IUI) cycle outcome. A total of 662 patients who were undergoing IUI were evaluated. Ovarian stimulation was started on day 3 with recombinant (r)FSH, followed by the GnRHa and recombinant human chorionic gonadotrophin (rHCG). The overall incidence of PL was 11.5%. In patients with and without PL, the pregnancy rates (PR) were 22.4 (17/76) and 17.7% (104/586) respectively. Patients with PL were divided into two groups: (i) those with increased serum progesterone [PR was 10.7% (3/28) in this group]; and (ii) patients with elevated serum LH but normal progesterone concentrations [PR was 29.2% (14/48) in this group]. Patients in the first group who did not become pregnant (n = 22) were administered GnRHa in a second IUI cycle, and the PR was 18.1%; however, some patients (n = 6; 27.3%) in this group still had high serum progesterone concentrations. In the second group, patients (n = 26) with elevated serum LH in the previous cycle were administered GnRHa in another IUI and the PR was 23.1%. Use of a GnRHa in patients with PL who have had a previous unsuccessful IUI may be an alternative in future attempts.
Related Concept Videos
Intrauterine Drug Delivery Systems
Hormonal Regulation of the Menstrual Cycle
At puberty, GnRH begins a pulsatile release pattern, which triggers the anterior pituitary gland to secrete follicle-stimulating hormone (FSH) and luteinizing hormone (LH). The frequency and amplitude of GnRH pulses vary across the menstrual cycle, with faster pulses favoring LH release and slower pulses favoring FSH release.
Ovarian Cycle
Hormonal Control of the Ovarian Cycle
Before puberty, the hypothalamus releases GnRH in a low frequency, low amplitude pulsatile manner. This along with the immature hypothalamic-pituitary-gonadal axis activity, results in low estrogen levels and the absence of a fully functional ovarian cycle. At puberty, GnRH secretion increases in both frequency and...
Infertility in Females
Endometriosis, a condition characterized by abnormal growth of endometrial...
Glucagon-like Receptor Agonists
GLP-1, when administered in high doses intravenously, triggers insulin secretion, inhibits glucagon release, slows gastric emptying, reduces food intake, and restores normal insulin secretion. However, its rapid inactivation by the...
