Presented by Hsin-Yang LiPresented by Hsin-Yang Li

OB/GYN Dept., Taipei VGHOB/GYN Dept., Taipei VGH

Premature LH SurgePremature LH Surge

Without the use of GnRH agonists or antaWithout the use of GnRH agonists or antagonists, premature LH surges occurs in gonists, premature LH surges occurs in 20% of gonadotropin stimulated cycles20% of gonadotropin stimulated cycles

Premature LH surges induces atresia of folPremature LH surges induces atresia of follicles and exerts negative effects on the enlicles and exerts negative effects on the endometriumdometrium

Ways to Prevent Premature LH Surge Ways to Prevent Premature LH Surge in Controlled Ovarian Stimulationin Controlled Ovarian Stimulation

(Coccia ME., et. al., 2004)

Most Commonly Used ProtocolsMost Commonly Used Protocols

(Semin. Reprod. Med., 2002)

Long GnRH agonist1. Slightly better pregnancy rate2. More injections needed

ConclusionConclusion

GnRH antagonist regimens:1) Endogenous FSH during the early follicular phase less synchronization of the follicular cohort less mature oocytes2) Endogenous LH during the early follicular phase slight progesterone endometrial receptivity for the embryos

Ways to improve GnRH antagonist regimens: 1) GnRH antagonist starts from FSH D12) OCP pretreatment x 18-28 d 2 d FSH GnRH antagonist from FSH D5-6