HIGH-DOSE GONADOTROPIN-RELEASING-HORMONE ANTAGONIST (GANIRELIX) MAY PREVENT OVARIAN HYPERSTIMULATION SYNDROME CAUSED BY OVARIAN STIMULATIONFOR IN-VITRO FERTILIZATION

This case report describes the first attempt to treat imminent ovarian hyperstimulation syndrome (OHSS) by using a gonadotrophin-releasing h ormone (GnRH) antagonist, A 33 year old, normo-ovulatory woman undergo ing in-vitro fertilization received daily subcutaneous injections of 1 50 IU of recombinant follicle-stimulating hormone (recFSH) from cycle day 2, together with GnRH antagonist (ganirelix) 0.125 mg from cycle d ay 7 onwards. On cycle day 10 the patient was found to have a serum oe stradiol concentration of 16 500 pmol/l and, on ultrasound examination , four preovulatory (>16 mm) and nine intermediate sized (10-16 mm) fo llicles, RecFSH injections were discontinued, human chorionic gonadotr ophin (HCG) withheld, whereas the ganirelix dose was increased to 2 mg /d, This regimen led to a rapid decrease in serum oestradiol concentra tions and the decrease in ovarian size on ultrasound. Since GnRH antag onists will become clinically available for in-vitro fertilization pro grammes in the near future this suggested regimen might have a role in preventing severe OHSS.