Taiwanese Journal of Obstetrics and Gynecology
Volume 45, Issue 4 , Pages 317-320, December 2006

Preliminary Report on the Effect of a Lower Dose of Gonadotropin-Releasing Hormone Antagonist (Cetrorelix) on Ovarian Hyperstimulation in Lower-Weight Asian Women

  • Yung-Ling Chang

      Affiliations

    • Department of Obstetrics and Gynecology, Tung's Metro Harbor Hospital, Taiwan
    • ,
  • Yao-Yuan Hsieh

      Affiliations

    • Department of Obstetrics and Gynecology, China Medical University Hospital, Taichung, Taiwan
    • ,
  • Horng-Der Tsai

      Affiliations

    • Department of Obstetrics and Gynecology, Changhua Christian Hospital, Changhua, Taiwan
    • Corresponding Author InformationCorrespondence to: Dr Horng-Der Tsai, Department of Obstetrics and Gynecology, Changhua Christian Hospital, 135 Nanhsiao Street, Changhua 500, Taiwan

Accepted 27 July 2006.

Article Outline

Summary 

Objective

To determine the minimal effective daily dose of gonadotropin-releasing hormone (GnRH) antagonist in lower-weight Asian women undergoing controlled ovarian hyperstimulation (COH).

Materials and Methods

A prospective randomized controlled trial of GnRH antagonist was performed. A total of 58 women with body weight of 40-50 kg accepted COH and transvaginal embryo transfer. Patients were divided into two groups: Group 1 patients (n = 28) were given a fixed cetrorelix dose of 0.2 mg/day; Group 2 patients (n = 30) were given a fixed cetrorelix dose of 0.15 mg/day. Cetrorelix was administered from menstrual day 8 until the day of human chorionic gonadotropin (hCG) administration. Serum luteinizing hormone (LH) and estradiol (E2) concentration were measured on the day of hCG administration. Gonadotropin dosages, LH and E2 concentrations, retrieved oocyte and embryo numbers, ovarian hyperstimulation syndrome (OHSS), embryo quality, and the rates of fertilization, implantation and pregnancy in both groups were compared.

Results

The clinical pregnancy/implantation rates in Group 1 were higher than those in Group 2 (28.6%/10.4% vs. 20%/4.1%). The numbers of oocytes retrieved/Grade I-II embryos were higher in Group 1 than Group 2 (10.5/7.8 vs. 8.3/3.9). A lower percentage of LH surge and higher E2 levels on the day of hCG adminstration were observed in Group 1 compared to Group 2 (5.9%/1,610.8 pg/mL vs. 26.7%/1,023.6 pg/mL). There were no statistical differences between the two groups when comparing gonadotropin dosage and OHSS.

Conclusion

The lowest effective dosage of cetrorelix is 0.2 mg in COH and pituitary downregulation for lower-weight Asian women.

Key Words:  cetrorelix , GnRH antagonist , IVF , ovarian hyperstimulation , pituitary downregulation

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References 

  1. Reissmann T , Schally AV , Bouchard P , Riethmiiller H , Engel J . The LHRH antagonist cetrorelix: a review . Hum Reprod Update . 2000;6:322–331
  2. Olivennes F , Fanchin R , Bouchard P , Taieb J , Frydman R . Triggering of ovulation by a gonadotropin-releasing hormone (GnRH) agonist in patients pretreated with a GnRH antagonist . Fertil Steril . 1996;66:151–153
  3. Diedrich K, Diedrich C, Santos E, Zoll C, Al-Hasani S, Reissmann T, et al. Suppression of the endogenous luteinizing hormone surge by the gonadotropin-releasing hormone antagonist Cetrorelix during ovarian stimulation . Hum Reprod . 1994;9:788–791
  4. Felberbaum R, Reissmann T, Kupker W, Al-Hasani S, Bauer O, Schill T, et al  Hormone profiles under ovarian stimulation with human menopausal gonadotropin (hMG) and concomitant administration of the gonadotropin releasing hormone (GnRH)-antagonist Cetrorelix at different dosages . J Assist Reprod Genet . 1996;13:216–222
  5. Borm G , Mannaerts B  The European Orgalutran Study Group . Treatment with the gonadotropin-releasing hormone antagonist ganirelix in women undergoing ovarian stimulation with recombinant follicle stimulating hormone is effective, safe and convenient: results of a controlled, randomized, multicentre trial . Hum Reprod . 2000;15:1490–1498
  6. Albano C , Smitz J , Camus M , Riethmuller-Winzen H , Van Steirteghem A , Devroey P . Comparison of different doses of gonadotropin-releasing hormone antagonist Cetrorelix during controlled ovarian hyperstimulation . Fertil Steril . 1997;67:917–922
  7. Albano C , Smitz J , Tournaye H , Riethmuller-Winzen H , Van Steirteghem A , Devroey P . Luteal phase and clinical outcome after human menopausal gonadotropin/gonadotropin releasing hormone antagonist treatment for ovarian stimulation in in vitro fertilization/intracytoplasmic sperm injection cycles . Hum Reprod . 1999;14:1426–1430
  8. Hsieh YY , Tsai HD , Chang CC , Chang CC , Lo HY . Comparison of a single half-dose, long-acting form of gonadotropin-releasing hormone analog (GnRH-a) and a short-acting form of GnRH-a for pituitary suppression in a controlled ovarian hyperstimulation program . Fertil Steril . 2000;73:817–820
  9. Gianaroli L , Ferraretti AP , Feliciani E , Tabanelli C , Magli C , Fertini D . Prospective randomized study of D-Trp-6-LHRH versus buserelin in long desensitization protocols for medically assisted conception cycles . Hum Reprod . 1994;9:220–225
  10. Fujimoto VY , Monroe SE , Nelson LR , Downey D , Jaffe RB . Dose-related suppression of serum luteinizing hormone in women by a potent new gonadotropin-releasing hormone antagonist (Ganirelix) administered by intranasal spray . Fertil Steril . 1997;67:469–473
  11. Oberye JJ , Mannaerts BM , Huisman JA , Timmer CJ . Pharmacokinetic and pharmacodynamic characteristics of ganirelix (Antagon/Orgalutran). Part II. Dose-proportionality and gonadotropin suppression after multiple doses of ganirelix in healthy female volunteers . Fertil Steril . 1999;72:1006–1012
  12. Gordon K , Williams RF , Danforth DR , Hodgen GD . A novel regimen of gonadotropin-releasing hormone (GnRH) antagonist plus pulsatile GnRH: controlled restoration of gonadotropin secretion and ovulation induction . Fertil Steril . 1990;54:1140–1145
  13. The ganirelix dose-finding study group  . A double-blind, randomized, dose-finding study to assess the efficacy of the gonadotropin-releasing hormone antagonist ganirelix (Org 37462) to prevent premature luteinizing hormone surges in women undergoing ovarian stimulation with recombinant follicle stimulating hormone (Puregon) . Hum Reprod . 1998;13:3023–3031
  14. Fauser BC, Devroey P, Yen SS, Gosden R, Crowley WF, Baird DT, et al. Minimal ovarian stimulation for IVF: appraisal of potential benefits and drawbacks . Hum Reprod . 1999;14:2681–2686
  15. Itskovitz-Eldor J , Kol S , Mannaerts B , Coelingh Bennink H . First established pregnancy after controlled ovarian hyperstimulation with recombinant follicle stimulating hormone and the gonadotrophin-releasing hormone antagonist ganirelix (Org 37462) . Hum Reprod . 1998;13:294–295
  16. Felberbaum R , Diedrich K . Ovarian stimulation for in vitro fertilization/intracytoplasmic sperm injection with gonadotrophins and gonadotrophin-releasing hormone analogues: agonists and antagonists . Hum Reprod . 1999;14:207–221

PII: S1028-4559(09)60250-3

doi:10.1016/S1028-4559(09)60250-3

Taiwanese Journal of Obstetrics and Gynecology
Volume 45, Issue 4 , Pages 317-320, December 2006

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