title: Induction of final follicle maturation with a gonadotropin-releasing hormone agonist in women at risk of ovarian hyperstimulation syndrome undergoing gonadotropin stimulation and intrauterine insemination: proof-of-concept study.
abstract: OBJECTIVE
  To evaluate the reproductive performance and safety of gonadotropin-stimulated intrauterine insemination (IUI) cycles in women at risk for ovarian hyperstimulation syndrome (OHSS) when final follicle maturation was induced using a gonadotropin-releasing hormone (GnRH) agonist.
  
  
  METHODS
  Thirty-three women presenting with a history of cancelled ovarian stimulation for fear of OHSS, underwent repeat gonadotropin ovarian stimulation for IUI. They were all found to be at high-risk for OHSS once more, and were counseled to receive a GnRH agonist to trigger final follicle maturation before insemination. GnRH agonist trigger of ovulation (triptorelin) was given subcutaneously every 12 hours in three repeated doses: 0.3, 0.2, 0.2 mg, respectively.
  
  
  RESULTS
  Induction with the agonist was associated with a 30.3% take-home pregnancy rate and 20% miscarriage rate. Multiple pregnancy rates were 26.7%. There were no reported cases of clinically significant moderate/severe ovarian hyperstimulation syndrome.
  
  
  CONCLUSIONS
  The use of a GnRH agonist to trigger final follicle maturation in stimulated cycles of hyper responders was associated with a favorable reproductive outcome and no incidence of OHSS. The rate of multiple pregnancies nevertheless was found to be uncontrollably elevated, raising serious concerns regarding the safety of this protocol in standard clinical practice in the context of IUI.
authors: Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon.
authors: J T
authors: JT
authors: Awwad
authors: A B
authors: AB
authors: Hannoun
authors: A
authors: A
authors: Khalil
authors: Z M H
authors: ZM
authors: Younes
authors: G S
authors: GS
authors: Ghazeeri
mesh_terms: D000328:Adult; D005260:Female; D005300:Fertility Agents, Female / Q000494:pharmacology; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists*; D006801:Humans; D007315:Insemination, Artificial; D008596:Menotropins / Q000494:pharmacology; D006080:Ovarian Follicle / Q000187:drug effects* / Q000502:physiology*; D016471:Ovarian Hyperstimulation Syndrome / Q000517:prevention & control; D011247:Pregnancy; D011272:Pregnancy, Multiple / Q000502:physiology; D017329:Triptorelin Pamoate / Q000494:pharmacology*
chemical_list: D005300:Fertility Agents, Female; D017329:Triptorelin Pamoate; D007987:Gonadotropin-Releasing Hormone; D008596:Menotropins