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Human Reproduction Update, Vol.6, No.4 pp.318-321, 2000
© European Society of Human Reproduction and Embryology 2000; all rights reserved

Induction of ovulation after GnRH antagonists

R. Ron-El1, A. Raziel1, M. Schachter1, D. Strassburger1, E. Kasterstein1 and S. Friedler1

1 IVF and Infertility Unit, Assaf Harofeh Medical Center, Zerifin 70300, Israel

To whom correspondence should be addressed at: R. Ron-El, IVF and Infertility Unit, Assaf Harofeh Medical Center, Zerifin 70300, Israel. Phone: 00972 8977 9005; Fax:'00972 8977 9003; e-mail: rronel{at}asaf.health.gov.il

Abstract

The gonadotrophin-releasing hormone (GnRH) antagonist binds competitively to the receptors and thereby prevents endogenous GnRH from exerting its stimulatory effect on the pituitary cells. This causes suppression of gonadotrophin secretion which occurs immediately after administration of the antagonist. When using GnRH antagonist in controlled ovarian stimulation, ovulation or maturation of the oocyte can, therefore, be induced by a variety of drugs, e.g. native GnRH, recombinant LH or short-acting GnRH agonists. Short-acting GnRH agonists were recommended for triggering ovulation in cases with a high risk of developing ovarian hyperstimulation syndrome (OHSS). Since it is evident that GnRH is required to initiate the LH surge and the oestradiol rise, a single administration of GnRH antagonist during the late follicular phase delays the LH surge. Studies showed that a single s.c. administration of 3 or 5 mg of Cetrorelix in the late follicular stage was sufficient to prevent the LH surge for 6--17 days. This phenomenon can be used in high responder patients who are prone to OHSS. The question whether this delay has any effect on oocyte quality and maturation still remains unanswered. Overall, there are four uses for GnRH antagonist: (i) using short-acting GnRH agonists for triggering ovulation in cases in which the GnRH antagonist is part of the protocol for ovarian stimulation. Recombinant LH and native LHRH could also be used as triggers of LH surge; (ii) delaying the LH surge in cases prone to OHSS by treatment with GnRH antagonist; (iii) to administer GnRH antagonist during the luteal phase to decrease the activity of corpora lutea; (iv) in polycystic ovarian disease with elevated LH the LH/FSH ratio can be corrected with the injection of GnRH antagonist prior to and during ovarian stimulation.

Key words: competitive blockade / GnRH antagonist / induction of ovulation / LH surge


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