title: Triggering ovulation with gonadotropin-releasing hormone agonist in in vitro fertilization patients with polycystic ovaries does not cause ovarian hyperstimulation syndrome despite very high estradiol levels.
abstract: OBJECTIVE
  To determine whether inducing ovulation with a GnRH agonist in patients with polycystic ovaries (PCO) would permit oocyte retrieval without the burden or risk of cancellation, coasting, or ovarian hyperstimulation syndrome (OHSS), thus maintaining pregnancy rates by allowing embryo cryopreservation for transfer in a subsequent cycle.
  
  
  METHODS
  Retrospective observational study.
  
  
  METHODS
  Private institution.
  
  
  METHODS
  Forty-two women who had previously experienced a controlled ovarian hyperstimulation (COH)/IVF cycle that had to be cancelled because of an elevated risk of OHSS.
  
  
  METHODS
  Forty-two PCO patients with a previous cancelled IVF cycle were assigned to a second controlled ovarian stimulation with recombinant FSH (75-150 IU/day) + GnRH antagonist (0.25 mg/day). Embryos were cryopreserved and transferred in a later cycle.
  
  
  METHODS
  OHSS, oocyte retrieval, and pregnancy rates.
  
  
  RESULTS
  In the first COH, the cycle had to be cancelled to avoid OHSS because E(2) serum levels were above safety levels (4809.6 +/- 2947.7). However, in the second cycle (ovulation triggered with a GnRH agonist) and independent of E(2) serum levels (4518.5 +/- 2118.85), all PCO patients eventually completed oocyte retrieval and frozen ET. With regard to pregnancy rates, 33% of patients receiving a transfer of a previously frozen embryo were successful. No patient developed OHSS.
  
  
  CONCLUSIONS
  Triggering ovulation with a GnRH agonist followed by embryo cryopreservation allows PCO patients to complete a COH/IVF cycle with no cycle cancellation, coasting, or OHSS and, finally, to attain good pregnancy rates.
authors.affiliation: Clinica FivMadrid, Juan Alvarez de Mendizabal, 28008 Madrid, Spain.
authors.forename: Maria A
authors.initials: MA
authors.lastname: Manzanares
authors.forename: Jose Lui
authors.initials: JL
authors.lastname: Gómez-Palomares
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Ricciarelli
authors.forename: Eleuterio R
authors.initials: ER
authors.lastname: Hernández
mesh_terms: D000328:Adult; D004958:Estradiol / Q000096:biosynthesis / Q000097:blood*; D005260:Female; D005307:Fertilization in Vitro / Q000009:adverse effects / Q000379:methods; D005640:Follicle Stimulating Hormone / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D007987:Gonadotropin-Releasing Hormone / Q000008:administration & dosage / Q000819:agonists* / Q000031:analogs & derivatives / Q000097:blood*; D006801:Humans; D016471:Ovarian Hyperstimulation Syndrome / Q000097:blood* / Q000139:chemically induced; D010062:Ovulation Induction / Q000379:methods; D011085:Polycystic Ovary Syndrome / Q000097:blood* / Q000188:drug therapy; D011247:Pregnancy; D011994:Recombinant Proteins / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D012189:Retrospective Studies
chemical_list: D011994:Recombinant Proteins; D007987:Gonadotropin-Releasing Hormone; D004958:Estradiol; D005640:Follicle Stimulating Hormone; C062876:cetrorelix