The Impact of a Gonadotropin-releasing Hormone Antagonist on Gonadotropin Ovulation Induction Cycles in Women with Polycystic Ovary Syndrome: a Prospective Randomized Study

Objective: To evaluate the effect of the gonadotropin-releasing hormone antagonist Ganirelix on gonadotropin ovulation induction (OI) in patients with polycystic ovary syndrome (PCOS).

Design: Prospective, randomized, controlled study.

Setting: Academic infertility center.

Patient(s): Ninety-eight anovulatory women with PCOS undergoing 154 gonadotropin OI cycles.

Intervention(s): Patients were treated with recombinant FSH alone (group 1) or in conjunction with Ganirelix when the leading follicle was ≥13 mm (group 2) versus from the beginning of stimulation (group 3), followed by IUI.

Main Outcome Measure(s): Per cycle clinical pregnancy rate (CPR), live-birth rate (LBR), total gonadotropin dose, days of stimulation, serum LH and peak E2, and premature luteinization rate.

Result(s): Data are suggestive of improved CPR in group 2 versus group 1 (33% vs. 19%) and LBR (35% vs. 20%) but not significantly different. Premature luteinization was highest in group 1 (21% vs. 1.8% in group 2 and 2.1% in group 3). Group 3 had the highest cancellation rate and cost without improving CPR and LBR. No differences were noted in peak serum E2, total gonadotropin dose, or days of stimulation.

Conclusion(s): Adding Ganirelix in a flexible protocol to gonadotropin OI cycles in women with PCOS may be beneficial by decreasing premature luteinization.