Ovarian Stimulation with Low-Dose Pure Follicle-Stimulating Hormone in Polycystic Ovarian Syndrome Anovulatory Patients:Effect of Long-Term Pretreatment with Gonadotrophin-Releasing Hormone Analogue

Abstract

A randomised clinical trial was performed to evaluate the effect of a 3-month gonadotrophin-releasing-hormone analogue (GnRH-a) in one cycle of ovulation induction with low-dose pure follicle-stimulating hormone (pFSH) in patients with polycystic ovarian syndrome (PCOS) anovulation. Twenty patients with chronic anovulation due to PCOS were randomised to ovulation induction with pFSH administered in a low-dose schedule with (10 patients) and without (10 patients) a 3-month pretreatment with GnRH-a. Ultrasound scan only monitoring of follicular growth, evaluation of plasmatic oestradiol at the day of triggering of ovulation with human chorionic gonadotrophin 5,000 IU and evaluation of plasmatic progesterone 8 days after were the main outcome measures. Ovulation occurred in 9 patients treated with pFSH and in 2 patients treated with GnRH-a plus pFSH. Five pregnancies in the pFSH group and no pregnancy in the GnRH-a group were obtained. Five cycles were stopped due to multifollicular growth in the GnRH-a group and 1 in the pFSH group. Pretreatment with a 3-month administration of a GnRH-a did not improve the ovulation rate and pregnancy rate in PCOS patient ovulation induction with low-dose pFSH.

Pharmacokinetics, safety, and tolerability of Pentoxifylline intravaginal gel for subfertile/ infertile couples with low sperm quality: phase I randomized controlled clinical trial in healthy women

“…555 [Evidence level 1a] One further RCT with pretreatment with GnRHa and FSH compared with FSH alone did not improve the pregnancy rate (0% versus 50%) or the ovulation rate (20% versus 90% RR 0.22; 95% CI 0.06 to 0.78). 556 [Evidence level 1b] When gonadotrophins were used concomitantly with GnRHa, the risk of OHSS was significantly increased (OR 3.15; 95% CI 1.48 to 6.70), but no conclusions could be drawn about miscarriage and multiple pregnancy rates due to insufficient data. 513 [Evidence level 1a]…”

GnRH Agonists, Antagonists, and Assisted Conception

“…112,114,115 Also, 3-month pretreatment with a GnRH agonist in ovulation induction with low-dose pure FSH did not improve ovulation and pregnancy rates. 116 GnRH agonists have also been employed to enhance responsitivity of patients with PCOS to other ovulation-induction drugs such as pulsatile GnRH. Rates of ovulation were disappointing, however, and miscarriage rates were as high as 45%.…”