title: High dose gonadotrophin-releasing hormone antagonist (ganirelix) may prevent ovarian hyperstimulation syndrome caused by ovarian stimulation for in-vitro fertilization.
abstract: This case report describes the first attempt to treat imminent ovarian hyperstimulation syndrome (OHSS) by using a gonadotrophin-releasing hormone (GnRH) antagonist. A 33 year old, normo-ovulatory woman undergoing in-vitro fertilization received daily subcutaneous injections of 150 IU of recombinant follicle-stimulating hormone (recFSH) from cycle day 2, together with GnRH antagonist (ganirelix) 0.125 mg from cycle day 7 onwards. On cycle day 10 the patient was found to have a serum oestradiol concentration of 16 500 pmol/l and, on ultrasound examination, four preovulatory (>16 mm) and nine intermediate sized (10-16 mm) follicles. RecFSH injections were discontinued, human chorionic gonadotrophin (HCG) withheld, whereas the ganirelix dose was increased to 2 mg/d. This regimen led to a rapid decrease in serum oestradiol concentrations and the decrease in ovarian size on ultrasound. Since GnRH antagonists will become clinically available for in-vitro fertilization programmes in the near future this suggested regimen might have a role in preventing severe OHSS.
authors.affiliation: Department of Obstetrics and Gynaecology, Dijkzigt Academic Hospital and Erasmus University Medical School, Rotterdam, The Netherlands.
authors.forename: D
authors.initials: D
authors.lastname: de Jong
authors.forename: N S
authors.initials: NS
authors.lastname: Macklon
authors.forename: B M
authors.initials: BM
authors.lastname: Mannaerts
authors.forename: H J
authors.initials: HJ
authors.lastname: Coelingh Bennink
authors.forename: B C
authors.initials: BC
authors.lastname: Fauser
mesh_terms: D000328:Adult; D004958:Estradiol / Q000097:blood; D005260:Female; D005307:Fertilization in Vitro; D005640:Follicle Stimulating Hormone / Q000008:administration & dosage / Q000378:metabolism; D007987:Gonadotropin-Releasing Hormone / Q000031:analogs & derivatives* / Q000037:antagonists & inhibitors* / Q000627:therapeutic use; D006727:Hormone Antagonists / Q000627:therapeutic use*; D006801:Humans; D007986:Luteinizing Hormone / Q000378:metabolism; D006080:Ovarian Follicle / Q000000981:diagnostic imaging; D016471:Ovarian Hyperstimulation Syndrome / Q000209:etiology / Q000517:prevention & control*; D010062:Ovulation Induction / Q000009:adverse effects*; D011994:Recombinant Proteins; D014463:Ultrasonography
chemical_list: D006727:Hormone Antagonists; D011994:Recombinant Proteins; D007987:Gonadotropin-Releasing Hormone; D004958:Estradiol; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone; C061018:ganirelix