GnRH antagonist does not prevent premature luteinization and ovulation in stimulated cycles with gonadotropins for IVF: two case reports

Abstract

The use of GnRH antagonists (GnRHant) is increasing in the ovarian stimulation protocol. Among several other benefits, GnRHant should prevent a premature luteinization and premature ovulation, the first described either as a ‘reassuringly rare event’ or ‘frequent event’, while the second as occurring more frequently in women with decreased ovarian reserve, advanced age and poor ovarian response. Two cases of associated premature luteinization and premature ovulation, during treatment with gonadotropins and GnRHant in IVF cycles, are here reported. In both cases, premature luteinization occurred and ovulation took place during ovarian stimulation protocols with exogenous gonadotropins and GnRHant, before reaching the criteria of hCG administration, regardless of the age of the patients and their ovarian reserve. Ovulation was documented by the disappearance of most of the developing follicles, by the transformation of endometrium from a triple line picture into a uniform hyper-echogenic image, by the presence of fluid in the pouch of Douglas, by the increase of progesterone plasma levels and the simultaneous reduction of estradiol plasma levels. This evidence can be important for a correct counseling with infertile patients in preparation for an IVF cycle.

Chinese abstract

GnRH拮抗剂(GnRHant)在卵巢刺激方案中的应用日益增多。在很多优势中, GnRHant应该有防止卵泡过早黄素化和早发排卵的作用, 前者被描述为”令人放心的罕见事件”或者”频繁事件”, 而后者更容易发生在卵巢储备降低、高龄和卵巢反应不佳的女性中。本文报道了在IVF周期中用促性腺激素和GnRHant治疗后与卵泡过早黄素化和早发排卵的两例病案报道。在这两个病案中, 未达到hCG注射标准之前, 不考虑患者的年龄与卵巢储备功能, 在使用外源性促性腺激素和GnRHant的卵巢刺激方案期中, 卵泡过早黄素化和早发排卵均有发生。排卵是根据最大发育卵泡的消失, 子宫内膜从三线图转化为均匀的高回声图像, 道格拉斯腔积液的出现, 血浆孕酮水平的增加, 同时雌二醇水平的降低来判断。这一证据对于那些准备做IVF的不孕患者得到正确的建议很重要。

Keywords:

• Infertility
• premature luteinization
• ovulation
• in vitro fertilization
• GnRH antagonist

Disclosure statement

No potential conflict of interest was reported by the authors.