- Email: [email protected]
Response: Single dose GnRH agonist administration in the luteal phase of assisted reproduction cycles: is the effect dependent on the type of GnRH analogue used for pituitary suppression?
Reproductive BioMedicine Online (2010) 20, 167
www.sciencedirect.com www.rbmonline.com
LETTER Response: Single dose GnRH agonist administration in the luteal phase of assisted reproduction cycles: is the effect dependent on the type of GnRH analogue used for pituitary suppression?
In conclusion, at present it cannot be stated whether luteal phase agonist administration in antagonist COH cycles is effective or not. There is an absolute need for future multi-centre trials to clarify this issue and we hope that these may eventually lead to another tool for luteal phase management.
To the Editor We read the comments by Ata and Urman (in this issue) relating to our article with great interest. The target of our study was the luteal phase management in antagonistadministered ovarian stimulation cycles. When the study by Ata et al. (2008) and ours (Isik et al., 2009) are compared it can be seen that the luteal phases were managed differently. We administered 1500 IU HCG intramuscularly once in addition to intravaginal micronized progesterone 600 mg daily. On the other hand Ata et al. (2008) only used 90 mg vaginal progesterone gel in their study. Moreover, the doses and types of agonists used for the luteal support were different. For that reason the meta-analysis conducted by Ata and Urman (in this issue) may not be valid. In addition to this we have been conducting a new controlled randomized trial comparing the effectiveness of single and multi-dose agonist administration in the luteal phase of ovarian stimulation cycles. During this study period a case has proved the effectiveness of agonist administration as a luteal support. A 36-year old poor-responder patient who had yielded four mature oocytes after antagonist stimulation inadvertently did not use progesterone and HCG support. Instead she only used the multi-dose agonist for luteal phase support and she became pregnant and this pregnancy is ongoing now.
References Ata, B., Urman, B., in this issue. Single dose GnRH agonist administration in the luteal phase of assisted reproduction cycles: is the effect dependent on the type of GnRH analogue used for pituitary suppression? Reprod. BioMed. Online 20. Ata, B., Yakin, K., Balaban, B., et al., 2008. GnRH agonist protocol administration in the luteal phase in ICSI-ET cycles stimulated with the long GnRH agonist protocol: a randomized, controlled double blind study. Hum. Reprod. 23, 668–673. Isik, A.Z., Caglar, G.S., Sozen, E., et al., 2009. Single-dose GnRH agonist administration in the luteal phase of GnRH antagonist cycles: a prospective randomized study. Reprod. BioMed. Online 19, 472–477.
AZ Isik Ankara Private IVF Centre, Ankara, Turkey G Caglar Ufuk University School of Medicine, Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Ankara, Turkey E-mail address: [email protected]
1472-6483/$ - see front matter ª 2009, Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.rbmo.2009.10.021
www.sciencedirect.com www.rbmonline.com
LETTER Response: Single dose GnRH agonist administration in the luteal phase of assisted reproduction cycles: is the effect dependent on the type of GnRH analogue used for pituitary suppression?
In conclusion, at present it cannot be stated whether luteal phase agonist administration in antagonist COH cycles is effective or not. There is an absolute need for future multi-centre trials to clarify this issue and we hope that these may eventually lead to another tool for luteal phase management.
To the Editor We read the comments by Ata and Urman (in this issue) relating to our article with great interest. The target of our study was the luteal phase management in antagonistadministered ovarian stimulation cycles. When the study by Ata et al. (2008) and ours (Isik et al., 2009) are compared it can be seen that the luteal phases were managed differently. We administered 1500 IU HCG intramuscularly once in addition to intravaginal micronized progesterone 600 mg daily. On the other hand Ata et al. (2008) only used 90 mg vaginal progesterone gel in their study. Moreover, the doses and types of agonists used for the luteal support were different. For that reason the meta-analysis conducted by Ata and Urman (in this issue) may not be valid. In addition to this we have been conducting a new controlled randomized trial comparing the effectiveness of single and multi-dose agonist administration in the luteal phase of ovarian stimulation cycles. During this study period a case has proved the effectiveness of agonist administration as a luteal support. A 36-year old poor-responder patient who had yielded four mature oocytes after antagonist stimulation inadvertently did not use progesterone and HCG support. Instead she only used the multi-dose agonist for luteal phase support and she became pregnant and this pregnancy is ongoing now.
References Ata, B., Urman, B., in this issue. Single dose GnRH agonist administration in the luteal phase of assisted reproduction cycles: is the effect dependent on the type of GnRH analogue used for pituitary suppression? Reprod. BioMed. Online 20. Ata, B., Yakin, K., Balaban, B., et al., 2008. GnRH agonist protocol administration in the luteal phase in ICSI-ET cycles stimulated with the long GnRH agonist protocol: a randomized, controlled double blind study. Hum. Reprod. 23, 668–673. Isik, A.Z., Caglar, G.S., Sozen, E., et al., 2009. Single-dose GnRH agonist administration in the luteal phase of GnRH antagonist cycles: a prospective randomized study. Reprod. BioMed. Online 19, 472–477.
AZ Isik Ankara Private IVF Centre, Ankara, Turkey G Caglar Ufuk University School of Medicine, Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Ankara, Turkey E-mail address: [email protected]
1472-6483/$ - see front matter ª 2009, Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.rbmo.2009.10.021