Preferred treatment of infertile women older than 37 years of age who demonstrate premature luteinization in the first evaluation cycle

Objective: To evaluate the efficacy of various treatments in abolishing premature luteinization in infertile women over 37 years old who are undergoing ovulation induction. Design: Prospective, nonrandomized study. Setting: Tertiary care medical clinic. Patient(s): Seventeen infertile women >37 years old in whom premature luteinization was detected during their evaluation (pretreatment) cycle. Intervention(s): The patients underwent three consecutive treatment cycles with clomiphene citrate (group A), hMG (group B), and a GnRH agonist plus hMG (group C). Main Outcome Measure(s): Premature luteinization, defined as a progesterone/E-2 ratio of >1 on the day of hCG administration. Result(s): Fifteen (88%) of the 17 patients in group A and 13 (76%) of the 17 patients in group B demonstrated premature luteinization. In contrast, only 1 (6%) of the 17 patients in group C had a progesterone/E-2 ratio of >1 on the day of hCG administration. The mean (+/-SD) E-2 level on the day of hCG administration was significantly higher in group C (1,236 +/- 772.7 pg/mL) than in group A (214.02 +/- 104.46 pg/mL) or group B (412.5 +/- 337 pg/mL). Conclusion(s): Pituitary desensitization with a GnRH agonist in conjunction with hMG may be of benefit for older infertile women who demonstrate early luteinization in their first evaluation cycle. (Fertil Steril(R) 2000; 73:321-4. (C)2000 by American Society for Reproductive Medicine.).