Ovulation induction and pregnancy in a woman with premature menopause following gonadotropin suppression with the gonadotropin releasing hormone antagonist, cetrorelix--a case report.
OBJECTIVE
To determine if ovulation and pregnancy could be achieved in a case of amenorrhea, estrogen deficiency, and markedly elevated serum follicle stimulating hormone (FSH) through reduction of the serum FSH by a gonadotropin releasing hormone antagonist.


METHODS
A 37-year-old woman with hypergonadotropic secondary amenorrhea related to two courses of chemotherapy with alkylating agents and abdominal radiation therapy (Hodgkin's disease and breast cancer) was treated with cetrorelix in an attempt to induce ovulation by lowering elevated serum FSH and hopefully restore sensitivity of the few remaining follicles by restoring down-regulated FSH receptors. She was monitored with serum estradiol (E2), FSH, luteinizing hormone (LH), progesterone (P) levels and sonography.


RESULTS
As the serum FSH dropped the serum E2 rose and peaked at 200 pg/ml after ten days of cetrotide. She conceived in that cycle. A viable ongoing pregnancy with appropriate ultrasound findings was demonstrated 40 days from conception.


CONCLUSIONS
This is the first case description of successful ovulation and pregnancy following induction of ovulation with the GnRH antagonist cetrorelix. The possibility exists that the ovulation was spontaneous but it seems unlikely. It has been estimated that the chance of spontaneous ovulation and pregnancy in cases of premature ovarian failure is 1:9,200.
Check
J H
JH
Univ. of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School at Camden, Cooper Hospital/University Medical Center, Dept. of Obstetrics and Gynecology, Division of Reproductive Endocrinology & Infertility, NJ, USA. laurie@ccivf.com
Katsoff
B
B
D000328:Adult; D000970:Antineoplastic Agents / Q000009:adverse effects; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000031:analogs & derivatives* / Q000037:antagonists & inhibitors / Q000627:therapeutic use; D006727:Hormone Antagonists / Q000627:therapeutic use*; D006801:Humans; D007247:Infertility, Female / Q000188:drug therapy*; D010062:Ovulation Induction / Q000379:methods*; D011247:Pregnancy; D011256:Pregnancy Outcome; D016649:Primary Ovarian Insufficiency / Q000188:drug therapy* / Q000209:etiology
D000970:Antineoplastic Agents; D006727:Hormone Antagonists; D007987:Gonadotropin-Releasing Hormone; C062876:cetrorelix