Is the retrieval of high numbers of oocytes desirable in patients treated with gonadotrophin-releasing hormone analogues (GnRHa) and gonadotrophins?

• Published in: Human reproduction (Oxford) 1989-07, Vol.4 (5), p.536-540
• Main Authors: Pellicer, A., Ruiz, A., Castellvi, R.M., Calatayud, C., Ruiz, M., Tarin, J.J., Miró, F., Bonilla-Musoles, F.
• Format: Article
• Language: English
• Subjects: Adult; Buserelin - pharmacology; Embryo Implantation - drug effects; Embryo Transfer; embryonic implantation; Estradiol - analysis; Female; Fertilization - drug effects; Fertilization in Vitro; Follicle Stimulating Hormone - pharmacology; GnRH analohues; Gonadotropins - pharmacology; Humans; Menotropins - pharmacology; oocytes; Oocytes - drug effects; Ovarian Follicle - drug effects; Pituitary Hormone-Releasing Hormones - pharmacology; Retrospective Studies
• ISSN: 0268-1161; 1460-2350
• DOI: 10.1093/oxfordjournals.humrep.a136940

Continuous administration of gonadotrophin-releasing hormone analogues (GnRHa) in patients stimulated for the purpose of IVF might have a direct effect on the ovary. We have evaluated the IVF outcome of patients treated with Buserelin and subsequently with a combination of follicle-stimulating hormone (FSH) and human menopausal gonadotrophin (HMG). Patients were divided into three groups according to the number of oocytes obtained by transvaglnal ultrasound-guided follicular aspiration: group 1 (n = 35), in which 1–5 oocytes were retrieved; group 2 (n = 30), in whom 6–10 oocytes were obtained; group 3 (n = 32), in whom ≥ 11 oocytes were collected. Only couples with normal semen samples at oocyte retrieval were included in this study. The dose of Buserelin employed was not different between groups. However, the amount of FSH/HMG necessary to reach an optimal response significantly (P < 0.01) decreased as follicular development increased. The quality of the oocytes obtained was evaluated based on the appearance of the oocyte-corona-cumulus complex, fertilization rate, morphological appearance of the embryos, and implanation rate. The fertilization rate was significantly (P < 0.01) decreased in group 3 (57.2%) In comparison with groups 1 (77.1%) and 2 (74.2%). There was no significant difference between the groups in the quality of the embryos obtained or the quality of those replaced into the uterus. The implantation rate per embryo transferred was significantly (P < 0.05) hIgher in group 1 (16.5%) in comparison with groups 2 (6.6%) and 3 (8.2%). Pregnancy rates per patient were 22.9, 23.3 and 25.0% respectively (NS), despite a significant (P < 0.001) Increase in the number of embryos replaced per patient in groups 2 (3.7 ± 0.2), and 3 (3.8 % 0.3) compared with group 1 (2.3 % 0.2). These data suggest that the retrieval of higher numbers of oocytes in women treated with GnRHa is correlated with oocytes of lower quality. This is manifested by a decreased fertilization rate as well as a lower implantation rate of the embryos replaced into the uterus.