The ultrashort flare GnRH-agonist/GnRH-antagonist protocol enables cycle programming and may overcome the “detrimental effect” of the oral contraceptive

29 06 2012

To the Editor:

I read with interest the recently published Reflections paper by Bosch (1) on the ongoing debate entitled: “Can we skip weekends in GnRH antagonist cycles without compromising the final outcome?” This article comprehensively covered the role of oral contraceptive (OC) pretreatment in patients undergoing the GnRH-antagonist controlled ovarian hyperstimulation (COH) protocol for in vitro fertilization–embryo transfer (IVF-ET) cycle.

To summarize, while OC pretreatment results in “dual benefit”–a better synchronized response and a scheduled cycle–it was associated with a significantly lower ongoing pregnancy rate, longer duration of the stimulation, and higher gonadotropin consumption. The detrimental effect of OC pretreatment was related to the potential negative effect of the gestagen component on the endometrium, or the low endogenous LH levels induced by OCs with their deleterious impact on oocyte competence or endometrial receptivity. Regarding the latter, Bosch suggested the addition of LH or the use of hMG during COH, in order to overcome the negative influence of low LH. Read the rest of this entry »

Decline in serum AMH due to androgen action in early puberty in males

6 06 2012

To the Editor:

We read with interest the recent article by Hero et al. (1) showing that antimüllerian hormone (AMH) is one of the earliest signs of pubertal development in healthy boys, occurring before any notable increase in testis volume or serum testosterone. Owing to its longitudinal design, this study provides conclusive evidence for similar observations made in previous cross-sectional studies, indicating that the early increase in intratesticular testosterone is responsible for the inhibition of AMH expression (2-4). The authors conclude from their results that Sertoli cells must begin to express the androgen receptor before the clinical onset of puberty. Read the rest of this entry »