The effect of gonadotropin-releasing hormone agonist on the ovarian response and in vitro fertilization results in polycystic ovarian syndrome: A prospective study

Objective: To assess the effect of gonadotropin-releasing hormone agonist (GnRH-a) on pituitary suppression, subsequent ovarian response, and results of in vitro fertilization (IVF) treatments in polycystic ovarian syndrome (PCOS) patients. Design: Randomized prospective study. Setting: In vitro fertilization program and endocrinologic institute. Patients: Thirty patients with PCOS; 16 received GnRH-a, and 14 did not receive GnRH-a. Interventions: Ovum pick-up and embryo transfer. Main Outcome Measures: Response to GnRH-a test, serum and follicular fluid (FF) hormonal measurements, steroid levels, and aromatase activity in granulosa cell (GC) culture, and results of IVF. Results: Pituitary responsiveness was abolished in all patients 14 days after GnRH-a administration, and early luteinization was prevented. Steroid levels in FF did not differ between the two groups. In GC culture, progesterone (P) levels were higher in patients without the GnRH-a (3,704 ± 1,232 nmol/L versus 2,117 ± 235 nmol/L; P < 0.05) as were androstenedione (A) levels (5.3 ± 1.0 nmol/L versus <3.5 nmol/L; P < 0.05). However, aromatase activity and IVF results were similar in the two groups. Conclusions: Administration of GnRH-a in patients with PCOS decreases P and A production by the GC cells and prevents early luteinization. It does not affect the IVF results.