A Controlled Study of Luteinizing Hormone–Releasing Hormone Agonist (Buserelin) for the Induction of Folliculogenesis before in Vitro Fertilization

Treatment with clomiphene citrate and human menopausal gonadotropin (HMG) is often used to induce folliculogenesis before in vitro fertilization, but not all women have an adequate response. It has been hypothesized that abnormally high levels of luteinizing hormone (LH) may contribute to the reduced folliculogenesis. We therefore performed a controlled, open trial in which treatment with buserelin, an agonist of luteinizing hormone–releasing hormone, and HMG was compared with treatment with clomiphene citrate and HMG in 44 consecutive women in whom no oocytes or only one had been produced by standard treatment with clomiphene and HMG. twentynine women received buserelin with HMG, and 15 received clomiphene citrate with HMG. The median number of oocytes per patient recovered from those who received buserelin with HMG was 4 (range, 0 to 19), as compared with 0 (range, 0 to 5) in those who received clomiphene citrate with HMG. The fertilization rates of oocytes recovered from both groups of patients were similar (75.8 percent and 76.5 percent, respectively). Fifty-four percent of patients given buserelin with HMG underwent triple-embryo transfer, as compared with 13 percent of those given clomiphene citrate with HMG. Pregnancy (n = 3) occurred only among the patients receiving buserelin with HMG. In the buserelin–HMG group, significantly fewer oocytes were recovered from patients with occult ovarian failure (infertility and elevated follicular-phase levels of follicle-stimulating hormone, with regular menses) (median, 1; range, 0 to 4) than from those with other causes of infertility (median, 8; range, 0 to 19). Our data suggest that, except in women with occult ovarian failure, buserelin and HMG improve embryologic and clinical outcomes in patients with previously unsatisfactory stimulation of the ovaries for in vitro fertilization. (N Engl J Med 1989; 320:1233–7.) IN VITRO fertilization was developed as a treatment for infertility due to injury of the uterine tubes. 1 , 2 The first pregnancy induced with this method resulted from the fertilization of a single oocyte aspirated during a spontaneous menstrual cycle. 1 Subsequently, many investigators confirmed the finding that ovulatory stimulants such as clomiphene citrate and exogenous gonadotropins (human menopausal gonadotropin [HMG]) could be used to stimulate the growth of many follicles for use in in vitro fertilization. 2 The increased use of these drugs has revealed that folliculogenesis is inadequat