In a nutshell
This study investigated the effects of an early gonadotrophin-releasing hormone (GnRH) protocol in women with polycystic ovarian syndrome (PCOS).
They found that an early GnRH antagonist protocol may improve fertility outcome in women with PCOS.
Some background
Polycystic ovarian syndrome (PCOS) Is a common cause of female infertility. Patients with PCOS may not ovulate (release eggs). Controlled ovarian stimulation (COS) is a procedure to harvest eggs. Patients take a drug called follicle-stimulating hormone (FSH) to stimulate ovulation. Many PCOS patients undergo COS.
To prevent spontaneous ovulation, patients take medication that blocks a natural hormone, gonadotrophin-releasing hormone (GnRH). GnRH agonists (GnRH-AG) prevent natural GnRH from causing spontaneous ovulation. GnRH antagonists (GnRH-ANT) are drugs that block the GnRH receptor. Both of these drugs prevent spontaneous ovulation. GnRH-AGs are more likely to cause ovarian hyperstimulation syndrome (OHSS). OHSS is a serious side effect of COS. Some studies suggest that taking GnRH-ANT earlier might reduce OHSS rates. It is unclear if an early GnRH-ANT protocol compared to a conventional one improves fertility outcomes in patients with PCOS.
Methods & findings
This study included 36 women with PCOS. All patients took FSH for COS. Patients were then assigned to one of three groups. 11 women underwent a conventional protocol with GnRH-ANT at Day 6. 14 women received GnRH-ANT at Day 1. 11 women received GnRH-AG 3 days prior to FSH and through to the end of the protocol (long GnRH-AG). As per normal protocol, human chorionic gonadotrophin (hCG) was administered after FSH as required.
The rates of clinical pregnancy and rate of OHSS was not significantly different between the groups. Patients in the early GnRH-ANT groups had a trend for improved clinical pregnancy rates (50% vs. 11.1% with conventional GnRH-ANT, and vs. 22.2% with long GnRH-AG). There was a trend for reduced OHSS rates in early GnRH-ANT patients (7.7% vs. 18.2% with conventional GnRH-ANT, and vs. 27.3% with long GnRH-AG).
The bottom line
The authors concluded that an early GnRH antagonist protocol may improve fertility outcome in women with PCOS.
The fine print
The number of patients in this study was low. This may explain why the results were not statistically significant. Larger studies are needed to confirm these findings.
What’s next?
If you have any concerns regarding fertility treatment, please consult with your physician.
Published By :
Clinical and experimental reproductive medicine
Date :
Sep 01, 2018
