title: The gonadotropin-releasing hormone antagonist protocol--the protocol of choice for the polycystic ovary syndrome patient undergoing controlled ovarian stimulation.
abstract: Polycystic ovary syndrome (PCOS) patients are prone to develop ovarian hyperstimulation syndrome (OHSS), a condition which can be minimized or completely eliminated by the use of a gonadotropin-releasing hormone agonist (GnRHa) trigger. In this commentary paper, we maintain that the gonadotropin-releasing hormone antagonist protocol should be the protocol of choice for the PCOS patient undergoing ovarian stimulation with gonadotropins for in vitro fertilization. If an excessive ovarian response is encountered, the clinician will always have two options: either to trigger final oocyte maturation with a bolus of GnRHa and supplement the luteal phase with a small bolus of human chorionic gonadotropin in addition to the standard luteal phase support and transfer in the fresh cycle or, alternatively, to trigger with GnRHa and perform a total freeze, resulting in a complete elimination of OHSS and high ongoing pregnancy rates in the subsequent frozen-thawed transfer cycles.
authors.affiliation: Department of Obstetrics and Gynecology, IVF Unit, Rambam Medical Center, Haifa, Israel.
authors.forename: Shahar
authors.initials: S
authors.lastname: Kol
authors.forename: Roy
authors.initials: R
authors.lastname: Homburg
authors.forename: Birgit
authors.initials: B
authors.lastname: Alsbjerg
authors.forename: Peter
authors.initials: P
authors.lastname: Humaidan
mesh_terms: D006063:Chorionic Gonadotropin / Q000627:therapeutic use; D015925:Cryopreservation; D010064:Embryo Implantation / Q000187:drug effects; D004624:Embryo Transfer; D005260:Female; D005300:Fertility Agents, Female / Q000627:therapeutic use*; D005307:Fertilization in Vitro; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists*; D006801:Humans; D007247:Infertility, Female / Q000628:therapy; D008183:Luteal Phase; D009865:Oocytes / Q000187:drug effects / Q000254:growth & development; D016471:Ovarian Hyperstimulation Syndrome / Q000517:prevention & control*; D010062:Ovulation Induction; D011085:Polycystic Ovary Syndrome / Q000150:complications*
chemical_list: D006063:Chorionic Gonadotropin; D005300:Fertility Agents, Female; D007987:Gonadotropin-Releasing Hormone