NATIVE GONADOTROPIN-RELEASING-HORMONE FOR TRIGGERING FOLLICULAR MATURATION IN POLYCYSTIC-OVARY-SYNDROME PATIENTS UNDERGOING HUMAN MENOPAUSAL GONADOTROPIN OVULATION INDUCTION

Objective: To evaluate the role of GnRH administration instead of hCG for triggering follicular maturation in patients with polycystic ovari es (PCO) undergoing hMG ovulation induction when the late follicular 1 7-beta-E(2) levels are >1,600 pg/mL (>6,000 pmol/L). Design: Prospecti ve study. Setting: Infertility outpatient clinic of Rambam Medical Cen ter (general hospital), Haifa, Israel. Patients and Interventions: Hig h serum E(2) concentrations from 1,600 to >3,600 pg/mL (2,800 +/- 68, mean +/- SD [6,000 to >13,000 pmol/L, 10,279 +/- 2,500]) were experien ced in 44 hMG cycles. The number of preovulatory follicles visualized by transvaginal sonography was between 8 and 25. An IV injection of 20 0 mu g GnRH was administered for triggering final follicular maturatio n and ovulation, instead of 10,000 IU IM hCG, usually injected for thi s purpose, when the E(2) levels are less than or equal to 1,600 pg/mL (6,000 pmol/L). Serum E(2) and P levels were monitored in the luteal p hase. In cycles where E(2) decreased to less than or equal to 1,360 pg /mL (5,000 pmol/L), 2,500 IU hCG was administered once or twice at 3-d ay intervals for luteal support. Main Outcome Measures: Pregnancy and abortion rates and the rate of ovarian hyperstimulation syndrome (OHSS ). Results: Ten pregnancies were generated by the hMG and GnRH co-trea tment in 32 patients (31.2%), in 44 cycles (23%). Two pregnancies abor ted (20%), and eight generated eight healthy neonates. Ovarian hyperst imulation syndrome occurred in two cycles of patients who were both pr egnant. All but two of these PCO patients also have undergone 69 hMG a nd hCG cycles. Only 7 patients conceived (23%) 10 times (10/69, 14.5%) ; 5 of these pregnancies (50%) were multiple gestations (3 twins, 1 se xtuplet, and 1 heptuplet gestation). The pregnancy wastage rate was 30 % (3/10). Conclusion: The use of native GnRH to trigger ovulation in P CO patients with late follicular E(2) levels >1,600 pg/mL (6,000 pmol/ L) appears to be comparable with prior hMG and hCG cycles in terms of pregnancy rate, pregnancy wastage, risk of multiple gestation, and inc idence of severe ovarian hyperstimulation. Unlike hMG and GnRH-agonist , which is associated with luteal phase dysfunction, hMG and GnRH offe rs a preferable alternative due to the ability of hCG luteal support a nd rescue, providing the E(2) levels are not dangerously increased.