title: Gonadotrophin-releasing hormone analogue as an adjunct to gonadotropin therapy for clomiphene-resistant polycystic ovarian syndrome.
abstract: BACKGROUND
  Elevation of endogenous LH levels may result in premature luteinization. This may also be associated with the increased rate of spontaneous abortion. Gonadotropin releasing hormone analogue (GnRHa) used prior to human menopausal gonadotropin (hMG/FSH) administration may improve the outcome of ovulation induction.
  
  
  OBJECTIVE
  To assess if GnRHa pre-treatment plus FSH/hMG increase the rate of clinical pregnancy and/or decrease the rate of spontaneous abortion in women with WHO group 2 ovulatory dysfunction, compared with hMG/FSH alone.
  
  
  METHODS
  The Cochrane Subfertility Review Group specialised register of controlled trials was searched.
  
  
  METHODS
  All relevant published and unpublished RCTs were selected. Three RCTs were identified comparing these two approaches.
  
  
  METHODS
  
  
  
  METHODS
  A diverse search strategy was employed, including hand-search of 43 core journals from 1966 to the present, bibliographies of relevant trials, MEDLINE database, abstracts from North American and European meetings and contact with authors of relevant papers. Relevant data were extracted independently by two reviewers using the standardised data extraction sheet. Validity was assessed in terms of method of randomisation, completeness of follow-up, presence or absence of crossover and co-intervention.
  
  
  RESULTS
  2x2 tables were generated for all relevant outcomes. Odds ratios were generated using the Peto modified Mantel-Haenszel technique. Statistical heterogeneity was assessed using x2.
  
  
  RESULTS
  Studies were clinically and statistically homogenous. Common odds ratios for pregnancy per treatment cycle and moderate to severe ovarian hyperstimulation syndrome (OHSS) were 1.50 (0.72-3.12) and 1.40 (0.5-3.92) respectively.
  
  
  CONCLUSIONS
  These studies are too small to clearly demonstrate clinically significant differences in pregnancy rate between the two approaches. However, data from IVF studies suggest that there may be an increased risk of OHSS associated with GnRHa use. In the absence of evidence suggesting a benefit of GnRHa augmentation for PCOS, it should not be recommended as a standard treatment for this patient group. Further studies assessing live birth and OHSS rates are warranted.
authors.affiliation: Rm HSC-4F7, Department of Obstetrics and Gynaecology, McMaster University, 1200 Main St West, Hamilton, Ontario, Canada, L8N 3Z5. hughese@fhs.csu.mcmaster.ca
authors.forename: E
authors.initials: E
authors.lastname: Hughes
authors.forename: J
authors.initials: J
authors.lastname: Collins
authors.forename: P
authors.initials: P
authors.lastname: Vandekerckhove
mesh_terms: D002996:Clomiphene / Q000627:therapeutic use*; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D005260:Female; D005300:Fertility Agents, Female / Q000627:therapeutic use*; D007987:Gonadotropin-Releasing Hormone / Q000627:therapeutic use*; D006062:Gonadotropins / Q000627:therapeutic use*; D006801:Humans; D008596:Menotropins / Q000627:therapeutic use*; D011085:Polycystic Ovary Syndrome / Q000188:drug therapy*
chemical_list: D005300:Fertility Agents, Female; D006062:Gonadotropins; D002996:Clomiphene; D007987:Gonadotropin-Releasing Hormone; D008596:Menotropins