In 27 patients with the past history of poor response to the gonadotropin superovulation induction due to poor follicular growth or permature surge of endogenous luteinizing hormone, the effectiveness of pituitary supperssion with the
gonadotropin
releasing hormone agonist (GnRH-a) in vitro fertilization (IVF) program was evaluated in 43 cycles using a combination regimen of D-Trp-6 LHRH (Decapeptyl, Ferring) and FSH/hMG from June, 1989 to August, 1990 at Korea University Hospital IVF
Clinic.
At midluteal phase of menstrual cycle, Decapeptyl-CR was administered by long-term protocol to minimize initial agonistic effect of endogenous gonadotropins. After the confirmation of pituitary suppression, about 2-3 weeks after GNRH-a
administration,
ovarian follicle growth was stimulated with FSH/hMG and followed by transvaginal ultrasonic measurement of follicle size and by monitoring of serm E2 and LH if necessary. When compared with the control group stimulated with gonadotropin regimen
only,
the cancellation rate and occurrence rate of premature LH surge during gonadotropin treatment were significantly lower in study group (11.6% and 2.4%, respectively). There is no significant differences in the mean number of aspirated oocytes,
fertilization/cleavage rate, embryo transfer (ET) rate, and mean number of embryos transferred between the two groups. The pregnancy rate per treatment cycle, 16.3%, and per ET cycle, 23.3%, were significantly higher in the study group compared
with
those of control group.
These data suggest that GnRH-a therapy is effective for previous poor responder in gonadotropin superovulation induction for IVF.
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