Endocrinology: The development of functional ovarian cysts during pituitary down-regulation

This study investigated the development of functional ovariancysts during pituitary down-regulation prior to in-vitro fertilization(IVF), and identified 16 cases of cysts in 288 IVF cycles studied.Comparing the patients with functional ovarian cysts to theother 272 IVF cycles, there was no significant difference inage or incidence of endometriosis but significantly (P <0.01) more patients with cysts had ovulatory dysfunction. Theserum progesterone was <5.7 nmol/l in all 16 patients withcysts on day 4 of the IVF cycle, and in eight of these patientsthe serum progesterone was <5.7 nmol/l on the day buserelinwas commenced. In 10 of the 16 patients with cysts, serum oestradiolconcentrations remained elevated despite the prolonged use ofbuserelin, and the cysts were aspirated. The aspirate in allcases was clear without any suggestion of endometriosis. Thecyst aspirates had significantly lower progesterone (P <0.001), higher androstenedione (P < 0.01) and similar oestradiolconcentrations to 10 follicular fluid samples collected at thetime of oocyte retrieval. This study suggests that functionalovarian cysts may develop during pituitary down-regulation,and these cysts are follicular cysts rather than persistentcorpora lutea or endometriomata.