Ovarian hyperresponse to luteal phase GnRH-agonist administration.
BACKGROUND
Herein we report a case of ovarian hyperresponse after luteal phase GnRH-agonist administration in a woman planning to undergo ovarian stimulation for IVF in a long GnRH-agonist protocol.


METHODS
A normogonadotropic 25-year-old woman undergoing ICSI treatment for male factor infertility underwent three cycles of controlled ovarian stimulation, two in a GnRH-antagonist protocol, one in a long luteal GnRH-agonist protocol.


RESULTS
In the first GnRH-antagonist cycle, ovarian stimulation was performed with 150 IE recombinant FSH and 22 oocytes were retrieved. In the second GnRH-antagonist cycle using the same protocol, six oocytes were retrieved. The estradiol levels on the day of hCG administration were 3,692 and 3,209 pg/ml, respectively. In a third cycle, 3.75 mg triptorelin was administered in the luteal phase and the patient showed ovarian hyperresponse to the endogenous gonadotropin flare with estradiol levels of 19,102 pg/ml, abdominal distension and discomfort, and massive bilateral ovarian enlargement (total ovarian volume 268 cm(3)). Ovarian cysts persisted for 4 weeks and necessitated cyst aspiration before further treatment.


CONCLUSIONS
The flare-up effect of GnRH-agonist administration can, in rare cases, cause massive ovarian hyperresponse with associated health risks and significant postponement of treatment.
Depenbusch
Marion
M
Universitaet zu Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany.
Diedrich
Klaus
K
Griesinger
Georg
G
D005260:Female; D005299:Fertility Agents / Q000009:adverse effects*; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists*; D006801:Humans; D007248:Infertility, Male / Q000628:therapy; D008183:Luteal Phase; D008297:Male; D016471:Ovarian Hyperstimulation Syndrome / Q000139:chemically induced*; D020554:Sperm Injections, Intracytoplasmic; D017329:Triptorelin Pamoate / Q000009:adverse effects*; D055815:Young Adult
D005299:Fertility Agents; D017329:Triptorelin Pamoate; D007987:Gonadotropin-Releasing Hormone