Case Report: Accidental exposure to daily long-acting gonadotrophinreleasing hormone analogue administration and pregnancy in an in-vitro fertilization cycle

Abstract

A case of successful pregnancy in an in-vitro fertilization cycle, in spite of an accidental exposure to daily long-acting gonadotrophin-releasing hormone analogue administration, is reported. The patient underwent two intracytoplasmic sperm injection cycles with thawed epididymal spermatozoa, in which, due to a pharmacist's mistake, ovarian stimulation was carried out by a combination of long-acting gonadotrophin-releasing hormone agonist (leuprolide depot) and gonadotrophins. A successful singleton pregnancy was achieved after intrauterine embryo transfer with the birth of a healthy boy after 38 weeks. We describe the circumstances and results of this clinical case, as well as reviewing the literature.

GnRH agonist versus GnRH antagonist in ovarian stimulation: the role of endometrial receptivity

“…These observations might be further explained by either: the possible deleterious effect of GnRH antagonists, which have a known inhibitory effect on the cell cycle by decreasing the synthesis of growth factors (14); or the beneficial effect of GnRH agonists (15). Studies in monkeys have shown that GnRH agonists are secreted by the early embryo and that a lack of GnRH production is associated with impaired implantation (16).…”

Perinatal outcome of pregnancies after inadvertent exposure to gonadotrophin‐releasing hormone analogue

“…The median age of the patients was 35 years (range 28-39) and the median duration of infertility was 3.5 years (range 1.5-8). The median duration of inadvertent exposure to the GnRHa was 22 days (range [21][22][23][24][25].…”

“…Three studies have documented normal development of the child after delivery but these assessments were never validated by objective physical, neurological or physiological testing. 3,5,22 In the only study to date demonstrating any form of long-term effects of inadvertent exposure to GnRHa in pregnancy, it was shown that four out of six children in the study group had developed neurodevelopment problems such as epileptic disorder, attention deficit hyperactivity disorder, motor difficulties and speech difficulties. 23 We do acknowledge the limitations of our study in addressing these areas of concern and do recognise the need for further long-term follow-up of such children in light of the above observations.…”

Addition of gonadotropin releasing hormone agonist for luteal phase support in in-vitro fertilization: an analysis of 2739 cycles

“…It was observed that unintentional or accidental GnRH agonist administration in the luteal phase of IVF treatment cycles with pregnancies did not compromise the continuation of pregnancy but was observed to support implantation in initial reports (16)(17)(18)(19). Although well-defined mechanisms by which GnRH agonist addition improves luteal support are lacking, presumptive effect at multiple levels were proposed.…”