Human chorionic gonadotropin(hCG) and gonadotropin-releasing hormone agonist(GnRH-a), have been used to trigger the final stage of follicular maturation and ovulation induction before oocyte retrievl in vitro fertilization programs. GnRH-a or
hCG
were
thought to play a dominant role in regulating the follicular microenvironment, which in turn could influence the fertilizability of the oocyte in controlled ovarian hyperstimulation cycles. Recently GnRH-a is thought to be more physiological than
hCG,
but there has not been a detail study of the influence of GnRH-a compared with hCG on intrafollicular hormonal environment. The objective of the present investigation was to measure the preovulatory folliclular fluid(Ff) hormonal concentration
and
then
to compare the effectiveness of single midcycle dose of GnRH-a with hCG on follicular maturation and pregnancy rate.
From Apirl 1991 to June 1992, we retrospectively measured the concentrations of the preovulatory FF hormones from randomly selected 85 infertile women who were divided into Group I (GnRH-a group : 40 patients and 45 cycles) to receive 0.1mg
decapeptyl(r) (D-Trp-6-LHRH) and Group II(hCG group : 45 patients and 48 cycles) to receive 10,000 Iu hCG. Both groups underwent identical ovarian stimulation and cycle monitoring. Follicle growth was stimulated by the hMG regimen including first
3
days
of decapeptyl during the follicular phase and follicular aspiration by transvaginal sonography was performed 36 hours after GnRH-a or hCG given.
@ES We obtained the main results summerized as follows:
@EN 1. On the day of GnRH-a or hCG administration, serum E2 concentrations and the number of follicles≥18.0mm in diameter were not different in both groups.
2. FF E2 mean concentration was higher in group I and natural cycle compared with group II (P<0.05).
3. FF P4 mean concentration was lower in both groups than in natural cycle(P<0.001).
4. FF LH mean concentration was lower (P<0.05), but βhCG mean concentration was higher (P<0.001) in group II than in group I and natural cycle.
5. No differences were observed in the FF mean concentrations of PRL, T, and FSH in both groups and natural cycle.
6. Pregnancy rate was 39.1%(1846 of cycles) in group I and 25.0%(12/48 of cycles) in group II(P<0.05).
7. No differences were observed in the FF mean concentrations of E2, P4, PRL, T, FSH, LH and β-hCG between pregnant and notpregnant women involved in GnRH-a group.
The results of this study indicate that, the difference of follicular microenvironment triggered with GnRH-a compared with hCG is present, second, it could not be determined the correlation of the follicular microenvironment with oocyte quality
due
to
no difference of total fertilization rate or normal fertilization rate in the both groups and, third, the easier luteal support in the GnRH-a cycle than in the hCG cycle results to the increase of pregnancy rate.
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