Gonadotropin-releasing hormone agonists in assisted reproduction

Abstract

Pituitary down-regulation with gonadotropin-releasing hormone analogs (GnRH-a) prior to the onset of human menopausal gonadotropin (hMG) administration for superovulation (‘long protocol’) provides several advantages over hMG administration alone in programs of assisted reproduction such as in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). The cancellation rate for treatment cycles is dramatically reduced, pregnancy rates per started cycle (as well as per embryo transfer) are increased and strict programming with respect to the onset of hMG administration as well as to the time of human chorionic gonadotropin (hCG) administration – due to a large ‘hCG window’ – is possible. Thus, more than 95% of all punctures in the laborious IVF and ICSI programs can be performed during working days.

Using the GnRH-a/hMG ‘long protocol’ of ovarian stimulation, the pregnancy rates obtained for IVF with normospermic men and for ICSI with subfertile males were compared. In a subgroup of female patients no older than 31 years of age, with a transfer of three embryos, the pregnancy rate for IVF and for ICSI was 38.7 and 41.6% per cycle, respectively. The results demonstrate that ICSI renders subfertile men fertile in an IVF program.

Key Words:

• Gonadotropin-Releasing Hormone Agonist
• In Vitro fertilization
• Intracytoplasmic Sperm Injection