PubMed · 8156885
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K Mohr. 1994-04-08. Buserelin.. https://doi.org/10.1055/s-0029-1235042
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OBJECTIVE: To study ovarian stimulation and response patterns during a gonadotropin step-down dose regimen for induction of ovulation by applying a decremental dose regimen in polycystic ovary syndrome (PCOS) patients. DESIGN: The present prospective study involves 28 infertile clomiphene citrate-resistant PCOS patients during gonadotropin-induced cycles using a modified step-down dose regimen (and adjuvant GnRH agonist medication). Applied gonadotropin doses included initial daily doses of 150 IU IM followed by two reducing steps (37.5 IU each) based on sonographic criteria to a final daily dose of 75 IU IM. SETTING: Anovulatory infertile women in an academic referral center. INTERVENTION: Daily blood withdrawal and transvaginal pelvic ultrasound. MAIN OUTCOME MEASURES: Serum FSH and E2 concentration and follicle growth were investigated daily during gonadotropin administration. RESULTS: An initial 2.1-fold increase in serum FSH levels was observed followed by a subsequent decrease of 10% (median) per day for 4 days. Growth of ovarian follicles was sustained and ovulation achieved (midluteal P, 11.7 +/- 1.3 ng/mL; conversion factor to SI unit, 3.180; mean +/- SD) in 22 patients. Major variability in day 3 E2 increase (range, 67 to 866 pg/mL; conversion factor to SI unit, 3.671)--not related to differences in FSH serum concentrations and without changes in follicle number and size--suggests differences in ovarian sensitivity for FSH stimulation. A strong correlation (r = 0.82) was found between day 3 E2 increase and the chance of ovulation. Moreover, E2 levels on the day of gonadotropin dose reduction predict (r = 0.68) chances of late follicular phase E2 levels exceeding 871 pg/mL (conversion factor to SI value, 3.671). CONCLUSIONS: These findings provide the endocrine basis for the concept of gonadotropin induction of ovulation using a step-down dose regimen. Initial E2 increase (before initiation of follicle growth) represent differences in ovarian sensitivity to gonadotropins and predict treatment outcome.
We studied the peri-ovulatory and luteal phases in 38 human menopausal gonadotrophin (HMG)-stimulated cycles, in which ovulation was triggered with four different i.v. bolus ovulation triggers: 100 micrograms gonadotrophin-releasing hormone (GnRH; group A, n = 9), 500 micrograms GnRH agonist (GnRHa; group B, n = 10), 10,000 IU human chorionic gonadotrophin (HCG; group C, n = 10) and 500 micrograms GnRH (group D, n = 9). Endogenous luteinizing hormone (LH) surges occurred in all cycles of groups A, B and D. The rise was slowest but highest in group B (P < 0.0001) and lowest in group A. Although the t0 serum oestradiol values were similar in all groups, day +8 oestradiol and day +4 and +8 progesterone concentrations were higher in group C (P < 0.05). At day +4 and +8, serum LH concentrations were lowest (P < 0.01) but follicle stimulating hormone (FSH) concentrations were higher. Clinically, day +8 luteal scores showed a more conspicuous degree of ovarian hyperstimulation in the HCG group (P = 0.0292). Luteal insufficiency, defined as cycles with progesterone concentrations of < 8 ng/ml, occurred much more frequently in groups A, B and D than in group C (day +4: P < 0.0003; day +8: P < 0.0001), despite progesterone supplementation. Three pregnancies (one in group C and two in group D) and one moderate case of ovarian hyperstimulation syndrome (OHSS) (in a non-conceptional group D cycle) occurred. These findings show that (i) ovulation occurs and pregnancy can be achieved following an endogenous LH surge induced by GnRH and its agonists, (ii) a high frequency of luteal insufficiency occurs in such cycles even with luteal supplementation and (iii) OHSS cannot be totally prevented by this approach, although cycles with an endogenous LH surge in general result in fewer subclinical signs of ovarian hyperstimulation.
The present study was undertaken to evaluate a possible relationship between the endometrial concentrations of oestrogen receptor (ER) or progesterone receptor (PR), and the sonographic appearance of human endometrium. Sonographic assessments and aspirations of the endometrium at the time of or prior to ovulation were made in 48 cycles of 45 infertile women. Endometrial patterns were classified as A, triple line pattern, or B, not triple line, on the basis of echogenicity. We did not find a correlation between ER or PR and serum oestradiol or endometrial thickness. Furthermore, serum oestradiol concentrations were not correlated with endometrial pattern or thickness. The only significant correlations were found between the concentrations of ER and PR in the pattern A endometrium (r = 0.80, P < 0.01) and in the pattern B endometrium (r = 0.49, P < 0.05). There were no differences in the mean concentrations of ER and PR despite differences in endometrial pattern and thickness. However, PR was measured at > 800 fmol/mg protein in 12 out of 38 pattern A endometria, while PR was < 800 fmol/mg protein in all pattern B endometria. These data suggest that high PR expression in the pre-ovulatory period is related to an adequate endometrial growth and thereby increases the responsiveness of the endometrium to progesterone stimulation after ovulation.