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Hum. Reprod. Advance Access published online on October 27, 2005
Human Reproduction, doi:10.1093/humrep/dei371
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© The Author 2005. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Received September 7, 2005
Revised September 22, 2005
Accepted September 23, 2005

Article

Ovarian cyst formation following GnRH agonist administration in IVF cycles: incidence and impact

H.S. Qublan 1*, Z. Amarin 2, Y.A. Tahat 1, A.Z. Smadi 1, and M. Kilani 1

1 Infertility and IVF Center, King Hussein Medical Center, Amman, Jordan
2 Infertility and IVF Center, Jordan University of Science and Technology, Irbid, Jordan

* To whom correspondence should be addressed.
H.S. Qublan, E-mail: hqublan{at}yahoo.com


  Abstract

BACKGROUND: The formation of functional ovarian cysts has been recognized as one of the side effects of GnRH agonist administration. The formation of cysts during IVF treatment may be of no clinical significance or may negatively influence its outcome. The objective of this study was to determine the incidence of ovarian cyst formation following GnRH agonist administration and to examine their effect on IVF outcome. METHODS: A prospective study of 1317 IVF patients who developed one or more functional ovarian cysts of ≥15 mm following GnRH agonist treatment was performed. Transvaginal ultrasonographic-guided cyst aspiration was carried out in 76 randomly allocated patients out of 122 patients who were found to have functional ovarian cysts before starting ovarian stimulation with gonadotropins. RESULTS: The incidence of follicular cyst formation was 9.3%. Cyst cycles in comparison with noncyst cycles had significantly elevated day 3 basal FSH (mean ± SD of 8.3 ± 3.2 versus 5.3 ± 2.6 mIU/ml, P < 0.05) and required more ampoules of gonadotropins (46.3 ± 16.5 versus 35 ± 14.6, P <0.01). Furthermore, they showed a statistically significant decrease in the quality and number of oocytes retrieved, fertilization rate, number and quality of embryos, implantation and pregnancy rates, with a significant increase in cancellation and abortion rates. Patients with bilateral cysts had a significantly lower number of oocytes and embryos retrieved, with a lower proportion of metaphase II oocytes. They also had a higher proportion of poor quality embryos. Cyst aspiration was not associated with a significant difference in the above parameters. CONCLUSIONS: The incidence of cyst formation during GnRH agonist treatment is lower than previously reported. In such cases, the quality of oocytes and embryos were significantly compromised, with a significant increase in the cycle cancellation rate and a decrease in the implantation and pregnancy rates. Neither conservative management nor cyst aspiration improved the IVF outcome.

Keywords: follicular ovarian cyst/GnRH agonist/in vitro fertilization/pregnancy rate.
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