This case report describes the first attempt to treat imminent ovarian hyperstimulation syndrome (OHSS) by using a gonadotrophin-releasing hormone (GnRH) antagonist. A 33 year old, normo-ovulatory woman undergoing in-vitro fertilization received daily subcutaneous injections of 150 IU of recombinant follicle-stimulating hormone (recFSH) from cycle day 2, together with GnRH antagonist (ganirelix) 0.125 mg from cycle day 7 onwards. On cycle day 10 the patient was found to have a serum oestradiol concentration of 16 500 pmol/l and, on ultrasound examination, four preovulatory (>16 mm) and nine intermediate sized (10-16 mm) follicles. RecFSH injections were discontinued, human chorionic gonadotrophin (HCG) withheld, whereas the ganirelix dose was increased to 2 mg/d. This regimen led to a rapid decrease in serum oestradiol concentrations and the decrease in ovarian size on ultrasound. Since GnRH antagonists will become clinically available for in-vitro fertilization programmes in the near future this suggested regimen might have a role in preventing severe OHSS.

*Fertilization in Vitro, Adult, Estradiol/blood, Female, Follicle Stimulating Hormone/administration & dosage/secretion, Gonadotropin-Releasing Hormone/*analogs & derivatives/*antagonists & inhibitors/therapeutic use, Hormone Antagonists/*therapeutic use, Humans, Luteinizing Hormone/secretion, Ovarian Follicle/ultrasonography, Ovarian Hyperstimulation Syndrome/etiology/*prevention & control, Ovulation Induction/*adverse effects, Recombinant Proteins
hdl.handle.net/1765/8814
Human Reproduction
Erasmus MC: University Medical Center Rotterdam

de Jong, D, Macklon, N.S, Mannaerts, B.M, Coelingh-Bennink, H.J.T, & Fauser, B.C.J.M. (1998). High dose gonadotrophin-releasing hormone antagonist (ganirelix) may prevent ovarian hyperstimulation syndrome caused by ovarian stimulation for in-vitro fertilization. Human Reproduction. Retrieved from http://hdl.handle.net/1765/8814