Induction of pre-ovulatory luteinizing hormone surge by gonadotrophin-releasing hormone agonist for women at risk for developing the ovarian hyperstimulation syndrome

Ovarian hyperstimulation syndrome (OHSS) is a major risk inpatients undergoing ovulation induction protocols. Withholdinginjection of human chorionic gonadotrophin (HCG) may preventthe development of OHSS, but can also result in failure to ovulateand conceive. We have used a gonadotrophin-releasing hormoneagonist (GnRHa) as an alternative to HCG in women not undergoingin-vitro fertilization in an attempt to prevent OHSS. The studyincluded 12 cycles in 12 women scheduled for ovulation inductionwith human menopausal gonadotrophin (HMG) who were at risk ofdeveloping OHSS (oestradiol>3500 pg/ml, number of follicles>20).GnRHa was injected to induce the pre-ovulatory, luteinizinghormone surge which triggers follicular maturation. Progesteronewas administered for luteal support. Six pregnancies were achieved,and none of the 12 women developed OHSS. Since the pregnancyrate in this study was acceptable, we can recommend the useof GnRHa instead of HCG in any case at risk of developing OHSS