Evaluation of ovarian cysts following GnRH-a treatment in patients with polycystic ovarian syndrome

The aim of this study was to evaluate the ovarian cysts appearing during Gn RH-a/hMG treatment in patients with polycystic ovarian syndrome (PCOS). A t otal of 35 women with PCOS were included in the study. All women received 3 .75 mg IM of long-acting leuprolide acetate on the first day of the menstru al cycle. On the 15th day of the menstrual cycle, transvaginal ultrasound e xamination (US) and determination of serum E-2 were done. A total of 90 cyc les were studied in this way and during these cycles, 14 (15.5%) ovarian cy sts with a diameter of greater than or equal to 20 mm developed. According to the serum E-2 levels, 11 cases (group A) had E-2 concentrations > 35 pg/ ml and 3 (group B) had serum E-2 levels < 35 pg/ml. Group A patients attain ed a significantly larger mean size of ovarian cyst than group B patients(4 2 +/- 7.3 vs. 24.2 +/- 3.2 mm, p < 0.001). When the serum E-2 concentration s were < 35 pg/ml, the ovarian cysts were disregarded and ovarian stimulati on with gonadotropins was initiated. In case that serum E-2 levels were > 3 5 pg/ml, the initiation of the ovarian stimulation with hMG was postponed u ntil serum E-2 levels indicated down-regulation, which was achieved after 5 .8 +/- 2.9 days. In both groups the ovarian stimulation resulted in ovulato ry cycles, while four pregnancies in group A and one in group B were achiev ed. In conclusion, our results indicate that in patients with PCOS the GnRH -a administration may cause follicular cysts at an incidence of 15.5%. Thes e cysts do not constitute a contraindication for ovarian stimulation provid ed that serum E-2 levels are low.