High dose gonadotrophin-releasing hormone antagonist (ganirelix) may prevent ovarian hyperstimulation syndrome caused by ovarian stimulation for in-vitro fertilization |
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Authors: | de Jong D; Macklon NS; Mannaerts BM; Coelingh Bennink HJ; Fauser BC |
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Institution: | Department of Obstetrics and Gynaecology, Dijkzigt Academic Hospital and Erasmus University Medical School, Rotterdam, The Netherlands. |
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Abstract: | This case report describes the first attempt to treat imminent ovarian
hyperstimulation syndrome (OHSS) by using a gonadotrophin-releasing hormone
(GnRH) antagonist. A 33 year old, normo-ovulatory woman undergoing in-vitro
fertilization received daily subcutaneous injections of 150 IU of
recombinant follicle-stimulating hormone (recFSH) from cycle day 2,
together with GnRH antagonist (ganirelix) 0.125 mg from cycle day 7
onwards. On cycle day 10 the patient was found to have a serum oestradiol
concentration of 16 500 pmol/l and, on ultrasound examination, four
preovulatory (>16 mm) and nine intermediate sized (10-16 mm) follicles.
RecFSH injections were discontinued, human chorionic gonadotrophin (HCG)
withheld, whereas the ganirelix dose was increased to 2 mg/d. This regimen
led to a rapid decrease in serum oestradiol concentrations and the decrease
in ovarian size on ultrasound. Since GnRH antagonists will become
clinically available for in-vitro fertilization programmes in the near
future this suggested regimen might have a role in preventing severe OHSS.
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