First live birth following IVF-embryo transfer and use of GnRHa alone for ovarian stimulation

Several case reports have shown that some patients may develop ovarian cysts or ovarian hyperstimulation syndrome following the administration of gonadotrophin-releasing hormone agonist (GnRHa). This is the first report of a live birth following ovarian stimulation and IVF-embryo transfer using sole administration of GnRHa as part of the short protocol. The 31-year-old woman was referred to IVF because of severe male factor. Following spontaneous menses, ovulation induction was started by administering a conventional flare-up regimen (triptorelin 0.1 mg) on day 1 of the cycle. On day 3, the oestradiol concentration was 444 pg/ml and the progesterone concentration was 0.3 ng/ml. On day 4, about 10 follicles, 8-10 mm in size, were detected in each ovary, and the oestradiol concentration rose to 704 pg/ml (progesterone was unchanged). Surprisingly, on day 9, the follicles were 18-19 mm in diameter, oestradiol had increased to 3678 pg/ml and progesterone was now 2.88 ng/ml. Informed consent was obtained for administering human chorionic gonadotrophin and for performing ovum retrieval 36 h later. Nineteen MII oocytes were retrieved, and all were fertilized, yielding high-quality embryos. Two embryos were transferred, and the patient conceived and recently gave birth to a healthy singleton.