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.

  • Itai Bar-Hava

    This is indeed the main point
    The analog flare enables high rate of implantation and whenever the pregnancy HCG start to rescue the corpus luteum no further luteal support is needed and therefore the known down regulation phenomenon does not occurs

  • Paweł _

    Interesting paper however Authors didn’t mention the desensibilization issue it occurs after 7-10 days during agonist therapy – this could provoke secondary deficiency after ET – Any opinions?

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