THE BEHAVIOR OF FOLLICLE CYSTS FORMED AFTER LONG-ACTING GONADOTROPIN-RELEASING-HORMONE ANALOG ADMINISTRATION IN PATIENTS WITH POLYCYSTIC OVARIAN SYNDROME

This study was conducted to examine the effect of ovarian cysts that d evelop after administration of a gonadotropin-releasing hormone (GnRH) analog during an ovulation induction program for patients with polycy stic ovarian syndrome. Twenty-eight women received Decapeptyl Continuo us Release for 70 cycles starting on day 3 of the menstrual cycle, aft er exclusion of any ovarian pathology by transvaginal ultrasonography. Fifteen days later ultrasonography was again performed and serum estr adiol estimated. Cystic structures greater than or equal to 20 mm in t he ovaries were defined as follicle cysts. In three cycles follicle cy sts developed and low estradiol levels were measured (Group 1). In ano ther six cycles cysts developed after GnRH analog, and elevated estrad iol levels were found (Group 2). In the latter, estradiol decreased 3 to 7 days later, with cyst regression in three cases. Ovulation induct ion with human menopausal gonadotropin (hMG) was initiated only if the estradiol level was less than or equal to 20 pg/ml, otherwise inducti on was postponed until estradiol decreased, disregarding the presence of cysts. When 2 to 3 follicles were greater than or equal to 18 mm, a nd generally when estradiol levels were < 1500 pg/ml, human chorionic gonadotropin was administered. All the cycles were ovulatory and two w omen from Group 2 conceived. The development of follicle cysts with lo w serum estradiol levels after GnRH analog administration represents a benign condition and is not a contraindication for hMG stimulation. I n cases with elevated estradiol levels, ovulation induction can be pos tponed until the estradiol has decreased. Our study revealed good ovul atory and pregnancy rates as a result.