Effectiveness of cetrorelix for the prevention of premature luteinizing hormone surge during controlled ovarian stimulation using letrozole and gonadotropins: a randomized trial

Lee, Tsung-Hsien; Lin, Yu-Hung; Seow, Kok-Min; Hwang, Jiann-Loung; Tzeng, Chii-Ruey; Yang, Yu-Shih

doi:10.1016/j.fertnstert.2007.06.029

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Volume 90, Issue 1 , Pages 113-120, July 2008

Effectiveness of cetrorelix for the prevention of premature luteinizing hormone surge during controlled ovarian stimulation using letrozole and gonadotropins: a randomized trial

Tsung-Hsien Lee, M.D.
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Obstetrics and Gynecology, Chung Shan Medical University Hospital, Taichung, Taiwan
Yu-Hung Lin, M.D.
- Department of Obstetrics and Gynecology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
- College of Medicine, Fu Jen Catholic University, Sinchuang, Taiwan
Kok-Min Seow, M.D.
- Department of Obstetrics and Gynecology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
Jiann-Loung Hwang, M.D.
- Department of Obstetrics and Gynecology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
- College of Medicine, Fu Jen Catholic University, Sinchuang, Taiwan
- Department of Obstetrics and Gynecology, Taipei Medical University, Taipei, Taiwan
- Reprint requests: Jiann-Loung Hwang, M.D., Department of Obstetrics and Gynecology, Shin-Kong Wu Ho-Su Memorial Hospital, No. 95 Wen Chang Road, Shih Lin District, Taipei, Taiwan (FAX: 886-2-29297082).
Chii-Ruey Tzeng, M.D.
- Department of Obstetrics and Gynecology, Taipei Medical University, Taipei, Taiwan
Yu-Shih Yang, M.D., Ph.D.
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan

Received 11 April 2007; received in revised form 6 June 2007; accepted 6 June 2007. published online 05 December 2007.

Objective

To evaluate the effectiveness of a GnRH antagonist in preventing premature LH surge under a letrozole and gonadotropin protocol.

Design

Prospective, randomized clinical trial.

Setting

A teaching hospital and tertiary medical center.

Patient(s)

Sixty-one patients were randomly assigned into two letrozole and gonadotropin–treated groups. These were distinguished by the absence (group I) or presence (group II) of supplementation with 0.25 mg of cetrorelix.

Intervention(s)

Controlled ovarian stimulation with letrozole and gonadotropins, cetrorelix and intrauterine insemination.

Main Outcome Measure(s)

Rate of premature LH surge.

Result(s)

Compared with group I, the rate of premature LH surge was statistically significantly lower for group II (43.4% [13/30] vs. 19.4% [6/31]), but the amount of gonadotropins used was statistically significantly higher (817.5 ± 28.5 vs. 907.5 ± 27.3 IU). Patients with premature LH surge had a statistically significantly lower pregnancy rate (21.4% [9/42] vs. 0 [0/18]) relative to their unaffected counterparts.

Conclusion(s)

A flexible protocol of 0.25 mg of cetrorelix for IUI cycles appears to suppress the rate of premature LH surge during ovarian stimulation with letrozole and gonadotropins. However, the incidence of premature LH surge remains too high, and modification will be necessary before the application of cetrorelix to IVF treatment.

Key Words: Aromatase inhibitor, GnRH antagonist, premature LH surge, ovulation induction, pregnancy