J Korean Med Sci.  2011 Oct;26(10):1394-1396. 10.3346/jkms.2011.26.10.1394.

Ovarian Hyper-Response to Administration of an GnRH-Agonist Without Gonadotropins

• Park HT
• Bae HS
• Kim T
• Kim SH

• KMID: 1786002
• DOI: http://doi.org/10.3346/jkms.2011.26.10.1394

Abstract

Several case reports have indicated that a small subgroup of patients may develop ovarian hyperstimulation following the administration of gonadotropin-releasing hormone agonists (GnRHa) without gonadotropins. However, since only few such cases have been published, it is unclear what course to follow in subsequent cycles after ovarian hyperstimulation in the first cycle using only GnRHa. A 33-yr-old woman was referred to in vitro fertilization for oocyte donation. A depot preparation (3.75 mg) of tryptorelin without gonadotropins induced ovarian multifollicular enlargement with high estradiol level, and was followed by human chorionic gonadotropin administration and oocyte retrieval. In a subsequent cycle of the same patient, a low dose of tryptorelin (0.05 mg) did not induce ovarian hyperstimulation, and resulted in clinical pregnancy. This report shows potential management of ovarian hyperstimulation following the administration of GnRHa without gonadotropins.

Keyword

GnRH Agonist; IVF; Ovarian Hyperstimulation

MeSH Terms

Adult
Chorionic Gonadotropin/administration & dosage
Female
Fertilization in Vitro
Gonadotropin-Releasing Hormone/*agonists
Humans
*Oocyte Donation
Oocyte Retrieval
Ovarian Hyperstimulation Syndrome/*chemically induced
Ovary/*drug effects
Ovulation Induction/methods
Pregnancy
Triptorelin Pamoate/*administration & dosage/adverse effects

Figure

• 

  Fig. 1 Ultrasonographic finding of both ovaries. (A) Left ovary, (B) Right ovary.

Reference

1. Porter RN, Smith W, Craft IL, Abdulwahid NA, Jacobs HS. Induction of ovulation for in-vitro fertilisation using buserelin and gonadotropins. Lancet. 1984. 2:1284–1285.

2. Qublan HS, Amarin Z, Tahat YA, Smadi AZ, Kilani M. Ovarian cyst formation following GnRH agonist administration in IVF cycles: incidence and impact. Hum Reprod. 2006. 21:640–644.

3. Weissman A, Barash A, Shapiro H, Casper RF. Ovarian hyperstimulation following the sole administration of agonistic analogues of gonadotrophin releasing hormone. Hum Reprod. 1998. 13:3421–3424.

4. Hampton HL, Whitworth NS, Cowan BD. Gonadotropin-releasing hormone agonist (leuprolide acetate) induced ovarian hyperstimulation syndrome in a woman undergoing intermittent hemodialysis. Fertil Steril. 1991. 55:429–431.

5. Droesch K, Barbieri RL. Ovarian hyperstimulation syndrome associated with the use of the gonadotropin-releasing hormone agonist leuprolide acetate. Fertil Steril. 1994. 62:189–190.

6. Qublan HS, Beni-Merei Z, Megdadi M, Al-Quraan G. Ovarian hyperstimulation syndrome following the sole administration of injectable gonadotropin-releasing hormone agonist (triptorelin) for the pituitary down-regulation and in vitro fertilization treatment: report of two cases. Arch Gynecol Obstet. 2009. 279:221–223.

7. Zeleznik AJ. Follicle selection in primates: "many are called but few are chosen". Biol Reprod. 2001. 65:655–659.

8. Morales AJ, Laughlin GA, Bützow T, Maheshwari H, Baumann G, Yen SS. Insulin, somatotropic, and luteinizing hormone axes in lean and obese women with polycystic ovary syndrome: common and distinct features. J Clin Endocrinol Metab. 1996. 81:2854–2864.

9. Yoshimura Y, Nakamura Y, Ando M, Shiokawa S, Koyama N, Nanno T. Direct effect of gonadotropin-releasing hormone agonists on the rabbit ovarian follicle. Fertil Steril. 1992. 57:1091–1097.

10. Bussenot I, Azoulay-Barjonet C, Parinaud J. Modulation of the steroidogenesis of cultured human granulosa-lutein cells by gonadotropin-releasing hormone analogs. J Clin Endocrinol Metab. 1993. 76:1376–1379.

11. Azem F, Almog B, Ben-Yosef D, Kapustiansky R, Wagman I, Amit A. First live birth following IVF-embryo transfer and use of GnRHa alone for ovarian stimulation. Reprod Biomed Online. 2009. 19:162–164.