Intranasal gonadotropin releasing hormone agonist GnRHa for luteal phase support following GnRHa triggering a novel approach to avoid ovarian hyperstimulation syndrome in high responders

Authors:
Itai Bar-Hava, M.D., Yossi Mizrachi, M.D., Daphne Karfunkel-Doron, M.Sc., Yeela Omer, B.A., Liron Sheena, M.D., Nurit Carmon, Bs.C.D.R., Gila Ben-David, M.D.

Abstract:

Objective:
To study whether intranasal GnRH agonist (GnRHa) can be effectively used for luteal support in high-responder patients undergoing fresh-embryo transfer after ovulation induction with the use of GnRHa.

Design:
Retrospective cohort study.

Setting:
Private fertility clinic.

Patient(s):
Forty-six high-responder patients were administered a GnRHa ovulation trigger to avoid ovarian hyperstimulation syndrome (OHSS), followed by 2 weeks of daily intranasal GnRHa (nafarelin) for luteal-phase support. No additional progesterone supplementation was administrated.

Intervention(s):
Intranasal GnRHa for luteal-phase support.

Main Outcome Measure(s):
The primary outcome was ongoing clinical pregnancy rate.

Result(s):
High median progesterone levels were measured at midluteal phase and on the day of the first positive pregnancy test (190 nmol/L on both measures). We obtained 24 (52.1%) ongoing clinical pregnancies. None of the patients developed OHSS.

Conclusion(s):
Intranasal GnRHa is effective in achieving luteal-phase support in high-responder patients and avoiding OHSS.

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