Leuprolide acetate for inducing ovulation in women undergoing ovarian stimulation

Abstract

Objective: To determine whether leuprolide acetate (LA), given subcutaneously at the time of follicular maturity in stimulated cycles, can result in ovulation and in vivo fertilization.

Study design: Sixty-seven women underwent 91 cycles of ovarian stimulation (OS) and received a single subcutaneous injection of 1 mg of LA when follicular maturity was reached. Only clomiphene citrate (CC) was used for 15 cycles, CC/FSH for 66 cycles and human menopausal gonadotropin only for 10 cycles. Thirty-four cycles were in oligoovulatory women. Eighty-two cycles were combined with intra-uterine insemination.

Results: Viable pregnancies occurred in 21/91 cycles (23%). Forty-two women testing with home urinary luteinizing hormone (LH) kits noted a surge. Seventy-one or 71 cycles demonstrated a biphasic curve. Sixty-eight of 75 cycles demonstrated follicular collapse (91%). Six women had serum LH levels of 12 +/- 4, 136 +/- 22 and 17 +/- 3 mIU/mL before and 12 and 36 hours after LA, respectively.

Conclusion: LA successfully induced ovulation, fertilization and luteinization in women receiving OS. The pituitary LH response to LA appeared to be normal in women having OS. The pregnancy rate was similar to that generally observed with human chorionic gonadotropin (hCG). A large, prospective, randomized study may be warranted to compare LA to hCG since the subcutaneous route of LA administration and potential for reduced hyperstimulation could be significant advantages, making OS more practical and safe.