The impact of a gonadotropin-releasing hormone antagonist on gonadotropin ovulation induction cycles in women with polycystic ovary syndrome: a prospective randomized study

ObjectiveTo evaluate the effect of the gonadotropin-releasing hormone antagonist Ganirelix on gonadotropin ovulation induction (OI) in patients with polycystic ovary syndrome (PCOS).DesignProspective, randomized, controlled study.SettingAcademic 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.