Desensitization to urine-derived gonadotropins in a woman with secondary infertility.
BACKGROUND
Urine-derived gonadotropins have been used to treat infertility but may cause allergic reactions. IgE-mediated hypersensitivity reactions can be treated with desensitization, especially when new therapies such as recombinant human gonadotropins are unavailable.


OBJECTIVE
This case is described to highlight a successful intervention with desensitization in a woman with a complicated history of secondary infertility. She had been treated with ovulation-induction regimens, such as IVF-M (in vitro fertilization-human menopausal gonadotropin [hMG]) and IVF-C (human chorionic gonadotropin [hCG]), for intrauterine insemination. During treatment, however, she experienced reactions to IVF-M and IVF-C. Because she strongly wanted a baby and no alternative preparation was available, desensitization was attempted.


METHODS
Intradermal tests with IVF-M and IVF-C using both negative and positive controls were performed on the patient and four normal control subjects. Immediate wheal-and-flare reactions occurred only in the patient. ELISA and ELISA inhibition tests showed positive responses to IVF-M and IVF-C, but not to highly purified hMG, hCG, or D-mannitol, a preservative in IVF-M and IVF-C. Desensitization to IVF-M and IVF-C was done with a protocol used for parenteral desensitization to penicillin.


RESULTS
During the IVF-M desensitization, the intramuscular injections were well tolerated. For the next 2 days, daily administration of IVF-M was uneventful. Thirty-six hours later, desensitization to IVF-C was performed successfully. The patient had two intrauterine inseminations and became pregnant.


CONCLUSIONS
Nongonadotropin proteins in urine-derived gonadotropins cause IgE-mediated hypersensitivity reactions. Acute desensitization to urine-derived gonadotropins can be performed effectively, as shown in our current case.
Koh
Y I
YI
Department of Internal Medicine, Chonnam National University Medical School and Research Institute of Medical Science, Kwangju, Korea.
Choi
I S
IS
Lee
H C
HC
Na
H S
HS
Oh
S T
ST
D000328:Adult; D001667:Binding, Competitive; D006063:Chorionic Gonadotropin / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D003888:Desensitization, Immunologic; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D006969:Hypersensitivity, Immediate / Q000139:chemically induced / Q000150:complications / Q000628:therapy*; D007115:Immunization Schedule; D007073:Immunoglobulin E / Q000276:immunology; D007247:Infertility, Female / Q000150:complications*; D008596:Menotropins / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use
D006063:Chorionic Gonadotropin; D007073:Immunoglobulin E; D008596:Menotropins