In vitro fertilization management and results in stimulated cycles with spontaneous luteinizing hormone discharge.

During a period of 14 months, in an in vitro fertilization program, 97 ultrasonically guided follicular punctures were performed in women with premature spontaneous luteinizing hormone (LH) discharge (group I) and 217 in women with a normal LH value who received human chorionic gonadotropin injection as a surrogate LH surge (group II). All cycles were stimulated by clomiphene citrate plus human menopausal gonadotropin. In group I, oocytes were not recovered in 35% of punctures, compared with only 21.2% in group II (P less than 0.02). In cycles in which the serum 17 beta-estradiol (E2) levels was less than 1200 pg/ml and the number of follicles greater than or equal to 14 mm diameter monitored was less than three, 69% of punctures in group I and 36.7% of punctures in group II failed to yield oocytes. We suggest that patients stimulated in this way who have a spontaneous LH discharge with an E2 value of less than 1200 pg/ml and less than three follicles 14 mm in diameter present should not proceed to follicular puncture.