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.
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.
Manzanares
Maria A
MA
Clinica FivMadrid, Juan Alvarez de Mendizabal, 28008 Madrid, Spain.
Gómez-Palomares
Jose Lui
JL
Ricciarelli
Elisabetta
E
Hernández
Eleuterio R
ER
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
D011994:Recombinant Proteins; D007987:Gonadotropin-Releasing Hormone; D004958:Estradiol; D005640:Follicle Stimulating Hormone; C062876:cetrorelix