[GnRH agonist treatment for in vitro fertilization in hyperandrogenemia]

Luteinising hormone (LH) is essential for steroidogenesis and folliculogenesis. In hyperandrogenic patients, however, an increased androgen production with the consecutive development of polycystic ovaries is caused by elevated LH levels. Suppression of androgens by the use of a GnRH agonist (a) may be a causal therapeutic approach. Therefore, we initiated a study comparing the combined GnRHa/HMG stimulation with HMG alone in hyperandrogenic patients undergoing in-vitro fertilisation (IVF). Altogether, 62 cycles were treated. Group 1 (n = 33) received a single depot injection of 3.6 mg goserelin on cycle day 22 followed by individualised HMG stimulation 14 days later. Group 2 (n = 29) started with the HMG stimulation on cycle day 3. In group 1, a pregnancy rate per transfer of 36.4% was achieved compared to only 20% in group 2. There was a strikingly lower abortion rate in group 1 that resulted in a significantly higher on going pregnancy rate. The results are in favour of the combined GnRHa/HMG stimulation as a first line therapy for hyperandrogenic IVF patients.