ABSTRACT
Gonadoptrophin-releasing hormone (GnRH) agonists have initially been introduced in the field of reproductive medicine on an ‘off label use’ basis without preceding proper dose finding studies. As a result doses that were required for the original indication (i.e. prostate carcinoma) were used, begging the question whether these schemes would not lead to LH levels that were too low for the maintenance of proper follicle growth in some patients. During the era of follicle stimulation with HMG-a combination of FSH and LH (or hCG)- this aspect might stay unnoticed as there will always be a sufficient exogenous administration to sustain follicle growth, but this may change for some patients since the wide scale use of recombinant FSH devoid of any LH activity. Some authors have appropriately questioned the dosing for GnRH agonists: they have coined the term “micro dose”, but one should question this term as it may well be that what is considered normal may actually be a “macro dose.” Dose finding studies have only recently been performed, but uncontrolled studies with lower dosage have suggested an improvement in response for certain specific groups such as previous low responders. However none of these studies are prospective, randomized and controlled. So far, although it is possible that certain patients may benefit from lower dosages, there still is no proper scientific basis for either attitude. Therefore there is an urgent need for randomized controlled trials.
