Pregnancy outcome following exposure to gonadotrophin-releasing hormone analogue during early pregnancy: comparisons in patients with normal or elevated luteinizing hormone.
The outcomes of established pregnancies following the treatment of infertile women with pituitary down-regulation before and during treatment with ovulation induction and either intrauterine insemination or timed intercourse were reviewed. Once started on gonadotrophin-releasing hormone analogue (GnRHa) treatment, the patients were maintained on GnRHa therapy throughout the following luteal phase to facilitate the start of the next treatment cycle if no pregnancy was established. This resulted in patients taking GnRHa until a positive pregnancy test indicated cessation of the treatment. The aim of our study was to determine whether exposure to GnRHa during early pregnancy constituted a risk. Patients who were diagnosed as having elevated follicular phase luteinizing hormone (LH) concentrations during their investigations were analysed as a separate cohort to assess whether this diagnosis had implications with respect to pregnancy outcome. Out of 226 recorded clinical pregnancies, 173 were traced and the data collated: 16 cases resulted in clinical abortions, two were ectopic pregnancies and 155 women had live births at various ages of gestation. There were three pregnancies which were complicated by congenital abnormalities. Patients with elevated LH concentrations on examination showed a higher rate of total pregnancy loss than those with normal LH concentrations, despite the fact that the LH was suppressed during the cycle in which they conceived. The results suggest that pregnancy outcome is not adversely affected by GnRHa administration during the luteal phase of the conception cycle, and that the group diagnosed as having elevated LH concentrations may retain their propensity to higher rates of pregnancy loss even when their LH concentrations are suppressed during treatment.
Abu-Heija
A T
AT
University Department of Obstetrics and Gynaecology, Glasgow, UK.
Fleming
R
R
Yates
R W
RW
Coutts
J R
JR
D000328:Adult; D016022:Case-Control Studies; D015331:Cohort Studies; D003075:Coitus; D005260:Female; D005498:Follicular Phase / Q000097:blood; D007987:Gonadotropin-Releasing Hormone / Q000008:administration & dosage / Q000009:adverse effects* / Q000031:analogs & derivatives*; D006801:Humans; D007247:Infertility, Female / Q000188:drug therapy*; D007317:Insemination, Artificial, Homologous; D007986:Luteinizing Hormone / Q000097:blood*; D008875:Middle Aged; D010062:Ovulation Induction; D011247:Pregnancy; D011256:Pregnancy Outcome
D007987:Gonadotropin-Releasing Hormone; D007986:Luteinizing Hormone