The LH secretion is fundamental for the development of a normal luteal phase and for progesterone secretion. The luteal-phase defect induced by agonist administration is well known and studied, caused mainly by the profound pituitary suppression (78). The antagonist exerts a transitory LH inhibition and, hypothetically, the luteal phase is less disturbed. Some authors (78,79), comparing LH serum levels in the early and mid-luteal phase of hMG treated cycles with or without antagonist (Cetrorelix multiple dose), concluded that there is a decrease in LH serum levels in Cetrorelix groups. However, the implications of this phenomenon were not studied. In a small group of patients treated with Cetrorelix multiple doses without luteal support, no pregnancy was obtained (80). A recent study comparing triggering of ovulation with hCG, rec-LH, and Triptoreline in IVF patients without any luteal support and treated with GnRH-nts showed an abnormal luteal phase in those three regimens (81). However, it must be emphasized that the authors used Antide as an antagonist and those results might not be extrapolated to Cetrorelix or Ganirelix. Others (82) demonstrated that, comparing antagonist and agonist treatment, the granulosa cells cultured in vitro from IVF patients were less impaired, in terms of progesterone secretion, in the antagonist group. Ragni et al. (83) showed, on intrauterine insemination (IUI) cycles, that the utilization of GnRH-nt is safe and do not affect the luteal-phase duration or progesterone secretion. The fact that the intensity of the stimulation is much lower in IIU cycles could explain those contradictory results, as luteal phase is affected by strong stimulation regimens.
Until full scientific data and controlled studies are available, it seems preferable to maintain luteal support of GnRH-nt treated cycles.
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