June 30th, 2022

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Ovarian Estradiol Production in Vivo: Inhibitory Effect of Leuprolide Acetate
Authors:  Ania Kowalik, M.D., Larry Barmat, M.D., Mark Damario, M.D., Hung-Ching Liu, Ph.D., Owen Davis, M.D., and Zev Rosenwaks, M.D.
  OBJECTIVE: To determine the impact of reducing the
dose of gonadotropin-releasing hormone agonist (GnRHa)
for controlled ovarian
stimulation in in vitro fertilization
(IVF) on subsequent
response to stimulation and
cycle outcome.

database was searched to
identify patients who underwent
at least two cycles of ovarian stimulation at a
university-based medical center, and a retrospective
chart review was performed. Fifty-one patients whose
IVF stimulation protocols during the two cycles were
identical except for the leuprolide dosage utilized for
luteal pituitary suppression were included in the study.
Two leuprolide dosages were utilized for suppression: a
low dose, 0.5 mg daily, and a high dose, 1 mg daily. The
leuprolide dose was uniformly halved upon initiation of
gonadotropin stimulation; the gonadotropin dose and
preparation were identical in the two protocols. Day 3
follicle-stimulating hormone levels, duration of stimulation,
amount of gonadotropins required, midcycle and
peak estradiol levels, oocyte yield and implantation rates
were compared.

RESULTS: Lowering the dose of GnRH-a while maintaining
the same stimulation protocol resulted in a faster
estradiol rise and higher mean peak estradiol level. The
higher estradiol levels were obtained with a lower total
gonadotropin dose. The oocyte yield was not affected by
the stimulation protocol utilized.

CONCLUSION: Lowering the dosage of leuprolide allows
higher estradiol levels in those patients. This suggests
an inhibitory in vivo effect of leuprolide acetate on
ovarian steroidogenesis. (J Reprod Med 1998;43:413-417)
Keywords:  estradiol, leuprolide, ovary
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