Desensitization to urine-derived gonadotropins in a woman with secondary infertility

Background: Urine-derived gonadotropins have been used to treat infertility but may cause allergic reactions. IgE-mediated hypersensitivity reactions can be treated with desensitization, especially when new therapies such as recombinant human gonadotropins are unavailable. Objective: This case is described to highlight a successful intervention wi th desensitization in a woman with a complicated history of secondary infer tility. She had been treated with ovulation-induction regimens, such as IVF -M (in vitro fertilization-human menopausal gonadotropin [hMG]) and IVF-C ( human chorionic gonadotropin [hCG]), for intrauterine insemination. During treatment, however, she experienced reactions to IVF-M and IVF-C. Because s he strongly wanted a baby and no alternative preparation was available, des ensitization was attempted. Methods: Intradermal tests with IVF-M and IVF-C using both negative and pos itive controls were performed on the patient and four normal control subjec ts. Immediate wheal-and-flare reactions occurred only in the patient. ELISA and ELISA inhibition tests showed positive responses to IVF-M and IVF-C, b ut not to highly purified hMG, hCG, or D-mannitol, a preservative in IVF-M and IVF-C. Desensitization to IVF-M and IVF-C was done with a protocol used for parenteral desensitization to penicillin. Results: During the IVF-M desensitization, the intramuscular injections wer e well tolerated. For the next 2 days, daily administration of IVF-M was un eventful. Thirty-six hours later, desensitization to IVF-C was performed su ccessfully. The patient had two intrauterine inseminations and became pregn ant. Conclusions: Nongonadotropin proteins in urine-derived gonadotropins cause IgE-mediated hypersensitivity reactions. Acute desensitization to urine-der ived gonadotropins can be performed effectively, as shown in our current ca se.