Login Register Cart 0
Generic placeholder image

Combinatorial Chemistry & High Throughput Screening

Editor-in-Chief

ISSN (Print): 1386-2073
ISSN (Online): 1875-5402

Back
Journal Home About Journal Editorial Board Journal Insight Current Issue Volumes/Issues
Subscribe
Case Report

Ovarian Hyperresponse Following the Sole Administration of GnRH Agonist

Author(s): Cheng Chen, Lan Geng, Zhenhui Hou, Dan Liu, Fanhua Meng, Wenmin Ma* and Xi Xia*

Volume 25, Issue 6, 2022

Published on: 02 March, 2021

Page: [1082 - 1085] Pages: 4

DOI: 10.2174/1386207324666210302095049

Price: $65

Abstract

Background: The gonadotrophin-releasing hormone agonist (GnRHa) has gained widespread popularity in achieving pituitary suppression before ovarian stimulation with exogenous gonadotropins in assisted reproductive technology protocols. However, a very small part of patients may develop ovarian hyper response after the sole administration of GnRHa without gonadotropins.

Case Report: A 32-year-old female diagnosed with polycystic ovary syndrome presented for her second IVF cycle in our reproductive center. Twenty-eight days after 3.75mg triptorelin was administrated on day 2 of her menstrual cycle, bilateral ovaries were significantly enlarged and presented multiple cystic masses. The hormone profile was as follows: E24870pg/ml, P 13.19ng/ml, FSH 14IU/L, and LH 10.77IU/L. The patient felt symptoms of mild ovarian hyperstimulation syndrome. In the subsequent IVF treatment cycle, antagonist protocol was performed. It showed that follicles developed slowly and exogenous gonadotropins were used for 13 days. Finally, seven oocytes were obtained, and only one blastocyst graded 4BC formed.

Conclusion: Ovarian hyperstimulation following the sole administration of GnRHa can occur, but the mechanism is still not yet clear. Antagonist protocol may be an alternative fertility strategy, but the risk of poor embryo quality and low pregnancy rate of transplantation should be warned.

Keywords: GnRH agonist, ovarian hyperstimulation, assisted reproductive technology, polycystic ovary syndrome, gonadotropins, GnRHa.

« Previous Next »
Graphical Abstract

[1]
Umemmuo, M.U.; Efetie, E.R.; Agboghoroma, C.O.; Momoh, J.A.; Ikechebelu, J.I. Comparison of clinical efficacy of long- versus short-acting gonadotrophin-releasing hormone agonists for pituitary down regulation in In vitro fertilisation cycles. Niger. Postgrad. Med. J., 2020, 27(3), 171-176.
[http://dx.doi.org/10.4103/npmj.npmj_65_20] [PMID: 32687115]
[2]
Allahbadia, G.N.M.R. Ovarian Stimulation Protocols; Springer: New Delhi, 2016, pp. 121-134.
[http://dx.doi.org/10.1007/978-81-322-1121-1_10]
[3]
Toftager, M.; Bogstad, J.; Bryndorf, T.; Løssl, K.; Roskær, J.; Holland, T.; Prætorius, L.; Zedeler, A.; Nilas, L.; Pinborg, A. Risk of severe ovarian hyperstimulation syndrome in GnRH antagonist versus GnRH agonist protocol: RCT including 1050 first IVF/ICSI cycles. Hum. Reprod., 2016, 31(6), 1253-1264.
[http://dx.doi.org/10.1093/humrep/dew051] [PMID: 27060174]
[4]
Engmann, L.L.; Maslow, B.S.; Kaye, L.A.; Griffin, D.W.; DiLuigi, A.J.; Schmidt, D.W.; Grow, D.R.; Nulsen, J.C.; Benadiva, C.A. Low dose human chorionic gonadotropin administration at the time of gonadotropin releasing-hormone agonist trigger versus 35 h later in women at high risk of developing ovarian hyperstimulation syndrome - a prospective randomized double-blind clinical trial. J. Ovarian Res., 2019, 12(1), 8.
[http://dx.doi.org/10.1186/s13048-019-0483-7] [PMID: 30684970]
[5]
Wiser, A.; Klement, A.H.; Shavit, T.; Berkovitz, A.; Koren, R.R.; Gonen, O.; Amichay, K.; Shulman, A. Repeated GnRH agonist doses for luteal support: a proof of concept. Reprod. Biomed. Online, 2019, 39(5), 770-776.
[http://dx.doi.org/10.1016/j.rbmo.2019.07.031] [PMID: 31628035]
[6]
Castillo, J.C.; Haahr, T.; Martínez-Moya, M.; Humaidan, P. Gonadotropin-releasing hormone agonist for ovulation trigger - OHSS prevention and use of modified luteal phase support for fresh embryo transfer. Ups. J. Med. Sci., 2020, 125(2), 131-137.
[http://dx.doi.org/10.1080/03009734.2020.1736696] [PMID: 32366146]
[7]
de Ciantis, M.; Faure, C.; Heudel, P.E.; Tredan, O.; Rousset-Jablonski, C. Ovarian suppression failure during GnRH agonist treatment: A report of three breast cancer patients. J. Gynecol. Obstet. Hum. Reprod., 2018, 47(6), 261-264.
[http://dx.doi.org/10.1016/j.jogoh.2018.03.002] [PMID: 29510273]
[8]
Qublan, H.S.; Amarin, Z.; Tahat, Y.A.; Smadi, A.Z.; Kilani, M. Ovarian cyst formation following GnRH agonist administration in IVF cycles: incidence and impact. Hum. Reprod., 2006, 21(3), 640-644.
[http://dx.doi.org/10.1093/humrep/dei371] [PMID: 16253965]
[9]
Pinto, E.; Pinelo, S.; Osório, M.; Ferreira, C.; Serra, H.; Pires, I.; Barbosa, A.; Figueiredo, H.; Felgueira, E.; Tavares, A. Outcomes from ovarian hyperstimulation following the sole administration of gonadotrophin-releasing hormone agonist in the context of in vitro fertilization: report of two cases and review of the literature. Gynecol. Endocrinol., 2012, 28(7), 545-548.
[http://dx.doi.org/10.3109/09513590.2011.650745] [PMID: 22439899]
[10]
Almagor, M.; Hovav, Y. The development of an oocyte-containing follicle during gonadotrophin-releasing hormone agonist administration. Hum. Reprod., 2001, 16(8), 1698-1699.
[http://dx.doi.org/10.1093/humrep/16.8.1698] [PMID: 11473966]
[11]
Weissman, A.; Barash, A.; Shapiro, H.; Casper, R.F. Ovarian hyperstimulation following the sole administration of agonistic analogues of gonadotrophin releasing hormone. Hum. Reprod., 1998, 13(12), 3421-3424.
[http://dx.doi.org/10.1093/humrep/13.12.3421] [PMID: 9886527]
[12]
Yeh, J.; Barbieri, R.L.; Ravnikar, V.A. Ovarian hyperstimulation associated with the sole use of leuprolide for ovarian suppression. J. In Vitro Fert. Embryo Transf., 1989, 6(4), 261-263.
[http://dx.doi.org/10.1007/BF01132875] [PMID: 2515236]
[13]
Cherrière, F.; Arvis, P.; Le Pabic, E.; Bidet, M.; Jaffré, F.; Guivarc’h-Levêque, A. Equivalent live-birth rate in antagonist IVF/ICSI protocol after oocyte triggering with GnRH agonist supplemented with 1500 r-hCG the day of oocyte retrieval vs r-hCG: A case-control study. J. Gynecol. Obstet. Hum. Reprod., 2020, 49(6)101702
[http://dx.doi.org/10.1016/j.jogoh.2020.101702] [PMID: 32018042]
[14]
Deng, L.; Li, X.L.; Ye, D.S.; Blockeel, C.; Zhou, X.Y.; Chen, S.L.; Chen, X. A Second Dose of GnRHa in Combination with Luteal GnRH Antagonist May Eliminate Ovarian Hyperstimulation Syndrome in Women with 330 Follicles Measuring 311 mm in Diameter on Trigger Day and/or Pre-trigger Peak Estradiol Exceeding 10 000 pg/mL. Curr Med Sci, 2019, 39(2), 278-284.
[http://dx.doi.org/10.1007/s11596-019-2031-5] [PMID: 31016522]
[15]
Ying, Y.; Yang, T.; Zhang, H.; Liu, C.; Zhao, J. Prolonged pituitary down-regulation with full-dose of gonadotropin-releasing hormone agonist in different menstrual cycles: a retrospective cohort study. PeerJ, 2019, 7e6837
[http://dx.doi.org/10.7717/peerj.6837] [PMID: 31106057]
[16]
Mu, Z.N.; Sun, Z.G.; Song, J.Y.; Liu, H.G.; Qiao, Y.; Xia, Q.C. Effect of duration of gonadotropin releasing hormone agonist on the outcome of in vitro fertilization-embryo transfer in a short-acting long regimen. Libyan J. Med., 2019, 14(1)1652058
[http://dx.doi.org/10.1080/19932820.2019.1652058] [PMID: 31405338]
[17]
Katulski, K.; Podfigurna, A.; Czyzyk, A.; Meczekalski, B.; Genazzani, A.D. Kisspeptin and LH pulsatile temporal coupling in PCOS patients. Endocrine, 2018, 61(1), 149-157.
[http://dx.doi.org/10.1007/s12020-018-1609-1] [PMID: 29728876]
[18]
Popovic-Todorovic, B.; Santos-Ribeiro, S.; Drakopoulos, P.; De Vos, M.; Racca, A.; Mackens, S.; Thorrez, Y.; Verheyen, G.; Tournaye, H.; Quintero, L.; Blockeel, C. Predicting suboptimal oocyte yield following GnRH agonist trigger by measuring serum LH at the start of ovarian stimulation. Hum. Reprod., 2019, 34(10), 2027-2035.
[http://dx.doi.org/10.1093/humrep/dez132] [PMID: 31560740]
[19]
Malini, N.A.; Roy George, K. Evaluation of different ranges of LH:FSH ratios in polycystic ovarian syndrome (PCOS) - Clinical based case control study. Gen. Comp. Endocrinol., 2018, 260, 51-57.
[http://dx.doi.org/10.1016/j.ygcen.2017.12.007] [PMID: 29273352]
[20]
Deswal, R.; Nanda, S.; Dang, A.S. Association of Luteinizing hormone and LH receptor gene polymorphism with susceptibility of Polycystic ovary syndrome. Syst Biol Reprod Med, 2019, 65(5), 400-408.
[http://dx.doi.org/10.1080/19396368.2019.1595217] [PMID: 30958034]
[21]
Blumenfeld, Z. Fertility Preservation Using GnRH Agonists: Rationale, Possible Mechanisms, and Explanation of Controversy. Clin. Med. Insights Reprod. Health, 2019, 131179558119870163
[http://dx.doi.org/10.1177/1179558119870163] [PMID: 31488958]
[22]
Mehta, R.H.; Anand Kumar, T.C. Can GnRH agonists act directly on the ovary and contribute to cyst formation? Hum. Reprod., 2000, 15(3), 505-507.
[http://dx.doi.org/10.1093/humrep/15.3.505] [PMID: 10686187]

Rights & Permissions Print Cite
Article Metrics
34
1
© 2024 Bentham Science Publishers | Privacy Policy