title: Withdrawal of GnRH agonist decreases oestradiol and VEGF concentrations in high responders.
abstract: This study evaluated whether the withdrawal of a gonadotrophin-releasing hormone (GnRH) agonist before triggering ovulation reduces the incidence of ovarian hyperstimulation syndrome (OHSS) in high-risk infertility patients who were treated with gonadotrophins. GnRH agonist was withdrawn for 2 or 3 days when dominant follicles were ≥14 mm in diameter, according to the GnRH agonist long protocol. Non-withdrawal of GnRH agonist was used as control. The serum concentration of oestradiol on the ovulation trigger day was significantly decreased in the GnRH agonist withdrawal group compared with the control group (5750.78 ± 2344.77 pg/ml versus 8076.43 ± 1981.67 pg/ml); however, the number of retrieved oocytes and the fertilization rate were similar between the groups. In addition, the concentrations of vascular endothelial growth factor in plasma on day of human chorionic gonadotrophin administration and follicular fluid on the oocyte retrieval day were decreased following GnRH agonist withdrawal. In fresh embryo transfer cycles, rates of clinical pregnancy, implantation and OHSS were not different between the groups. When GnRH agonist withdrawal was followed by total embryos cryopreserved, the rate of OHSS was decreased compared with the control group (0% versus 8.70%). Clinical pregnancy rates in cryopreserved embryo transfer cycles were comparable between the two groups.
authors.affiliation: Center for Reproductive Medicine, Department of Obstetrics and Gynecology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing City 210008, China.
authors.forename: Li-Jun
authors.initials: LJ
authors.lastname: Ding
authors.forename: Bin
authors.initials: B
authors.lastname: Wang
authors.forename: Xiao-Yue
authors.initials: XY
authors.lastname: Shen
authors.forename: Gui-Jun
authors.initials: GJ
authors.lastname: Yan
authors.forename: Ning-Yuan
authors.initials: NY
authors.lastname: Zhang
authors.forename: Ya-Li
authors.initials: YL
authors.lastname: Hu
authors.forename: Hai-Xiang
authors.initials: HX
authors.lastname: Sun
mesh_terms: D000328:Adult; D002681:China / Q000453:epidemiology; D015925:Cryopreservation; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D004351:Drug Resistance; D004624:Embryo Transfer; D004622:Embryo, Mammalian; D004958:Estradiol / Q000097:blood*; D005260:Female; D005300:Fertility Agents, Female / Q000008:administration & dosage* / Q000009:adverse effects; D005307:Fertilization in Vitro; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists*; D006801:Humans; D015994:Incidence; D007247:Infertility, Female / Q000097:blood / Q000628:therapy*; D016471:Ovarian Hyperstimulation Syndrome / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D010062:Ovulation Induction / Q000009:adverse effects*; D011247:Pregnancy; D018873:Pregnancy Rate; D042461:Vascular Endothelial Growth Factor A / Q000097:blood*
chemical_list: D005300:Fertility Agents, Female; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D007987:Gonadotropin-Releasing Hormone; D004958:Estradiol
keywords: GnRH agonist; VEGF; gonadotrophins; oestradiol