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Hum. Reprod. Advance Access published online on September 11, 2006
Human Reproduction, doi:10.1093/humrep/del059
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© The Author 2006. 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 August 23, 2005
Revised February 2, 2006
Accepted February 7, 2006

Article

Ganirelix acetate causes a rapid reduction in estradiol levels without adversely affecting oocyte maturation in women pretreated with leuprolide acetate who are at risk of ovarian hyperstimulation syndrome*

Robert L. Gustofson 1, James H. Segars 1, and Frederick W. Larsen 2 *

1 Combined Federal Fellowship in Reproductive Endocrinology and Infertility at NIH, Walter Reed Army Medical Center, National Naval Medical Center and Uniformed Services University of the Health Sciences, Bethesda, MD; WRAMC Assisted Reproductive Technology Program, Walter Reed Army Medical Center, Washington, DC; Reproductive Biology and Medicine Branch, National Institute of Child Health and Human Development, NIH, Bethesda, MD, USA
2 Combined Federal Fellowship in Reproductive Endocrinology and Infertility at NIH, Walter Reed Army Medical Center, National Naval Medical Center and Uniformed Services University of the Health Sciences, Bethesda, MD; WRAMC Assisted Reproductive Technology Program, Walter Reed Army Medical Center, Washington, DC, USA

* To whom correspondence should be addressed.
Frederick W. Larsen, E-mail: frederick.larsen{at}na.amedd.army.mil


  Abstract

BACKGROUND: Elevated estradiol (E2) levels predispose to development of ovarian hyperstimulation syndrome (OHSS). Since GnRH antagonist is associated with a reduction in E2 levels, we hypothesized that GnRH-antagonist treatment of women down-regulated with GnRH agonist who are at risk of OHSS might reduce E2 levels and avoid cycle cancellation. METHODS: Retrospective study in a university-based assisted reproduction technology (ART) programme in 87 patients treated with long luteal (LL) or microdose flare (MDF) with ovarian hyperresponse and 87 control patients without ovarian hyperresponse. GnRH-antagonist (ganirelix acetate) treatment was started and leuprolide acetate discontinued in women who failed to respond to a reduction in gonadotrophin dosage. RESULTS: In the treatment group, there was a significant, reproducible reduction in serum E2 levels. Mean E2 at the start of ganirelix treatment was 4219.8 pg/ml and decreased in 24 h to 2613.7 pg/ml (36.7%; P < 0.001). An average of 24.9 ± 8.8 oocytes were obtained at retrieval and an average of 19.1 ± 8.0 were metaphase II (79.2%). Fertilization occurred in 13.9 ± 8.1 embryos (72.8%). In this high risk group, two cases of severe OHSS (2.3%) occurred. The ongoing pregnancy rate was 51.8%. Compared with the control group, there were no statistically significant differences in the rate of oocyte recovery, oocyte maturity, 2PN rate, fertilization, cancellation, OHSS or pregnancy. CONCLUSIONS: GnRH-antagonist treatment of women pretreated with GnRH agonist rapidly reduced circulating serum E2 without adversely affecting oocyte maturation, fertilization rates or embryo quality and resulted in a high pregnancy rate in this subgroup of patients at risk of OHSS.

Keywords: cycle cancellation/estradiol/ganirelix acetate/GnRH agonist and antagonist/OHSS.

*Paper presented at the Annual Meeting of the American Society of Reproductive Medicine, Montreal, Quebec, Canada, October 2005.


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