cetrorelix and Anovulation

When administered in the late follicular phase to prevent any LH surge, GnRH antagonists induce a sharp decrease in serum LH levels that may be detrimental for assisted reproductive technology cycle outcome. This decrease in LH levels is dose-dependant. Supplementation with recombinant LH when introducing GnRH antagonist leads to significant changes in E2 secretion. This is consistent with a key role of LH to ensure adequate steroidogenesis. This also indicates that a single dose of GnRH antagonist is able to decrease bioactive LH below a minimal threshold for optimal steroidogenesis. However, supplementation with rLH does not modify the number of retrieved oocytes, obtained embryos and the pregnancy rate. This is in line with the concept that folliculogenesis is mainly dependent on FSH and that the role of LH and E2 is not primordial. Indeed, the findings of our prospective randomized study do not support a systematic supplementation with rLH when introducing antagonist. However, further studies are necessary to determine whether a specific sub group of patients characterized by a low E2/oocyte ratio could benefit from rLH supplementation.

Topics: Adult; Anovulation; Biological Availability; Clinical Protocols; Dose-Response Relationship, Drug; Drug Monitoring; Drug Therapy, Combination; Estradiol; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Levonorgestrel; Luteinizing Hormone; Ovulation Induction; Pregnancy; Pregnancy Rate; Prospective Studies