Document Detail

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.
MedLine Citation:
PMID:  16966348     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Elevated estradiol (E(2)) levels predispose to development of ovarian hyperstimulation syndrome (OHSS). Since GnRH antagonist is associated with a reduction in E(2) levels, we hypothesized that GnRH-antagonist treatment of women down-regulated with GnRH agonist who are at risk of OHSS might reduce E(2) 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 E(2) levels. Mean E(2) 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 E(2) 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.
Robert L Gustofson; James H Segars; Frederick W Larsen
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Publication Detail:
Type:  Controlled Clinical Trial; Journal Article; Research Support, N.I.H., Intramural     Date:  2006-09-11
Journal Detail:
Title:  Human reproduction (Oxford, England)     Volume:  21     ISSN:  0268-1161     ISO Abbreviation:  Hum. Reprod.     Publication Date:  2006 Nov 
Date Detail:
Created Date:  2006-10-12     Completed Date:  2007-01-29     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8701199     Medline TA:  Hum Reprod     Country:  England    
Other Details:
Languages:  eng     Pagination:  2830-7     Citation Subset:  IM    
Reproductive Endocrinology and Infertility, NIH, Bethesda, MD, USA.
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MeSH Terms
Estradiol / blood*
Fertility Agents, Female / therapeutic use
Gonadotropin-Releasing Hormone / analogs & derivatives*,  pharmacology
Hormone Antagonists / pharmacology*
Leuprolide / therapeutic use*
Oocytes / drug effects,  physiology*
Ovarian Hyperstimulation Syndrome / prevention & control*
Pregnancy Outcome
Reference Values
Retrospective Studies
Reg. No./Substance:
0/Fertility Agents, Female; 0/Hormone Antagonists; 123246-29-7/ganirelix; 33515-09-2/Gonadotropin-Releasing Hormone; 50-28-2/Estradiol; 53714-56-0/Leuprolide

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