nafarelin and Infertility

To determine the outcome of spontaneous conceptions in women who received GnRH agonists during mid-luteal phase down-regulation before IVF treatment.. Retrospective analysis of case records and study of the literature.. Two university-affiliated reproductive medicine units.. Seventy-three women who conceived spontaneously after starting down-regulation with a GnRH agonist before controlled ovarian hyperstimulation.. None.. Course and clinical outcome of pregnancies.. Seventy-four pregnancies occurred in 73 women who received a GnRH agonist. Of these patients, 6 (8%) had a biochemical pregnancy, 6 (8%) had an ectopic pregnancy, 21 (28%) miscarried, and 41 pregnancies resulted in successfully delivered babies; there were 2 cases of congenital abnormalities.. These cases, together with other published data, suggest that pregnancy outcome is not adversely affected by exposure to GnRH agonist during luteal-phase down-regulation. A central register of pregnant women who received a GnRH agonist is needed.. The aim was to determine the outcome of spontaneous conceptions in women who received gonadotropin-releasing hormone agonists (GnRH-a) during mid-luteal phase down-regulation before in vitro fertilization treatment. The authors reviewed available literature and retrospectively studied 73 patients from two infertility centers in Melbourne, Australia, who became pregnant after they began to take GnRH-a before controlled ovarian hyperstimulation. The main outcome measures were the course and clinical outcome of pregnancies. 74 pregnancies occurred in 73 women who received GnRH-a. Of these patients, 6 (8%) had a biochemical pregnancy, 6 (8%) had an ectopic pregnancy, 21 (28%) had a miscarriage, and 41 pregnancies resulted in successfully delivered babies, with 2 cases of congenital abnormalities. These cases, together with other published data, indicate that pregnancy outcome is not adversely affected by exposure to GnRH-a during luteal phase down-regulation. A central register of pregnant women who received GnRH-a is needed.

Topics: Buserelin; Down-Regulation; Female; Fertility Agents, Female; Fertilization in Vitro; Humans; Infertility; Leuprolide; Male; Nafarelin; Outcome Assessment, Health Care; Pregnancy; Retrospective Studies

Due to inherent differences between gonadotrophin-releasing hormone (GnRH) antagonists and agonists, their late effect on ovarian steroidal production during the luteal phase of IVF cycles may differ. The aim of this study was to characterize and compare the luteal phase hormonal profile after the use of GnRH antagonists or agonists in ovarian stimulation protocols for IVF, in non-conception cycles, to avoid the effect of human chorionic gonadotrophin (HCG) during the luteal phase in conception cycles. Seventy-eight normo-ovulatory patients <35 years old, undergoing IVF due to male or tubal infertility were randomly allocated either to a GnRH antagonist (study group) or GnRH agonist treatment (control group). Similar standard luteal support was given to all patients, using vaginal micronized progesterone. In non-conception cycles, no statistically significant differences were found comparing luteal phase. oestradiol or progesterone levels in the study and control groups. No statistically significant differences were found comparing the hormonal profile dynamics, the mid-luteal (HCG day +8) oestradiol/progesterone ratio and the percentage of mid-luteal oestradiol decline between the study and control groups. In conclusion, similar characteristics and dynamics of luteal phase oestradiol and progesterone were demonstrated comparing ovarian stimulation for IVF using GnRH agonist or antagonists, under similar luteal support.

Topics: Adult; Analysis of Variance; Estradiol; Female; Gonadotropin-Releasing Hormone; Gonadotropins; Humans; Immunoenzyme Techniques; Infertility; Israel; Luteal Phase; Nafarelin; Ovulation Induction; Pregnancy; Pregnancy Outcome; Progesterone; Treatment Outcome

To study whether intranasal GnRH agonist (GnRHa) can be effectively used for luteal support in high-responder patients undergoing fresh-embryo transfer after ovulation induction with the use of GnRHa.. Retrospective cohort study.. Private fertility clinic.. Forty-six high-responder patients were administered a GnRHa ovulation trigger to avoid ovarian hyperstimulation syndrome (OHSS), followed by 2 weeks of daily intranasal GnRHa (nafarelin) for luteal-phase support. No additional progesterone supplementation was administrated.. Intranasal GnRHa for luteal-phase support.. The primary outcome was ongoing clinical pregnancy rate.. High median progesterone levels were measured at midluteal phase and on the day of the first positive pregnancy test (190 nmol/L on both measures). We obtained 24 (52.1%) ongoing clinical pregnancies. None of the patients developed OHSS.. Intranasal GnRHa is effective in achieving luteal-phase support in high-responder patients triggered with GnRHa and avoiding OHSS.

Topics: Administration, Intranasal; Adult; Drug Administration Schedule; Embryo Transfer; Female; Fertility Agents, Female; Fertilization in Vitro; Follicle Stimulating Hormone, Human; Gonadotropin-Releasing Hormone; Hormone Antagonists; Humans; Infertility; Menotropins; Nafarelin; Oocyte Retrieval; Ovarian Hyperstimulation Syndrome; Ovulation; Ovulation Induction; Pregnancy; Pregnancy Rate; Recombinant Proteins; Retrospective Studies; Risk Factors; Treatment Outcome