High dose gonadotrophin-releasing hormone antagonist (ganirelix) may prevent ovarian hyperstimulation syndrome caused by ovarian stimulation for in-vitro fertilization

This case report describes the first attempt to treat imminent ovarianhyperstimulation syndrome (OHSS) by using a gonadotrophin-releasing hormone(GnRH) antagonist. A 33 year old, normo-ovulatory woman undergoing in-vitrofertilization received daily subcutaneous injections of 150 IU ofrecombinant follicle-stimulating hormone (recFSH) from cycle day 2,together with GnRH antagonist (ganirelix) 0.125 mg from cycle day 7onwards. On cycle day 10 the patient was found to have a serum oestradiolconcentration of 16 500 pmol/l and, on ultrasound examination, fourpreovulatory (>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 regimenled to a rapid decrease in serum oestradiol concentrations and the decreasein ovarian size on ultrasound. Since GnRH antagonists will becomeclinically available for in-vitro fertilization programmes in the nearfuture this suggested regimen might have a role in preventing severe OHSS.