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KMID : 0358419940370010067
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Korean Journal of Obstetrics and Gynecology
1994 Volume.37 No. 1 p.67 ~ p.76
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The Efficacy of the Combined Treatment of Nafarelin (Intranasal GnRH Agonist ) and hMG/hCG in Ovulation Induction for in Vitro Fertilization
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Abstract
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The most exciting recent development of ovarian stimulation for in vitro fertilization (IVF) has been the widespread use of gonadotropin-releasing hormone analygues(GnRH-a) to prevent premature luteinizing hormone(LH) surges, to increase the
average
number of oocytes obtained at retrieval and to increase the pregnancy rate. Many different forms of GnRH-a have been approved for use with varied routes of administration.
Because intransal GnRH-a offers a simple and noninvasive route of administration, we performed this study to evluate the effectiveness of pituitary suppression with intransal GnRH-a for IVF.
Between January and June 1993, 35 patients(35cycles)were received combined Nafarelin and hMG treatment. Starting on day 21 of the previous menstrual cycle, Nafarelin was intransasally administered in a dose of 400μg twice dally and when
pituitary-ovarian suppression had been acieved as indicated by an serum estradiol(E2) of less than 30pg/ml during Nafarelin administration and then hMG 150~225IU/d was administered from COH#3. Control group(28patients, 28 cycles) were
administered
by
hMG/hCG.
@ES The results as follows:
@EN 1. Serum E2 level significantly decreased from 367.7±204.3pg/ml (Nafarelin#1) to 22.7±29.3pg/ml (Nafarelin#15=COH#3) by daily administration of Nafarelin for pituitary suppression(P<0.05).
2. There was no change in serum LH and FSH levels during suppression phase, LH from 16.2±10.9mIU/ml to 12.3±8.2mIU/ml and FSH from 9.8±4.8mIU/ml to 13.2±18.5mIU/ml.
3. There was no occurrence of premature LH surge during COH in study group.
4. Two cycles in study group were cancelled due to poor follicular growth(5.7%).
5. On day of hCG administration, there was no difference in the number of dominant follicles(≥14.0 mm in diameter) in both groups(12.1±5.9vs9.8±5.7).
6. There was no difference in the number of retrieved oocytes in both groups(7.2±3.7vs8.1±6.0).
7. Number of cleaved oocytes in study group (5.0±3.4)were significantly increased than in control group(1.5±1.2)(P<0.01).
8. Pregnancy rate in study group (20.6%)was higher than incontrol group(6.7%).
These data suggest that intranasal Nafarelin can be successfully used in pituitary suppression as adjuncts to ovulation induction with hMG/hCG for IVF.
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KEYWORD
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