Gonadotropin-releasing hormone agonist administration in early human pregnancy is associated with normal outcomes

To evaluate the reproductive outcomes of early human gestations exposed to GnRH agonist (GnRH-a). Gonadotropin-releasing hormone agonist is commonly used as an adjunct to ovulation induction regimens, and sometimes early pregnancies are inadvertently exposed to the drug. There has been concern regarding possible teratogenic effects of GnRH-a on these gestations, but there is a paucity of data regarding human subjects.

Identified pregnancies were followed for obstetric and fetal outcomes.

Over 4 years 18 early pregnancies among 17 women were found to be exposed to GnRH-a. During the month of conception, daily injections were begun on menstrual day 22 after documenting an ovulatory P level on day 21. Gonadotropin-releasing hormone agonist was discontinued from 10 to 24 days later, immediately after pregnancy was recognized. Obstetric and fetal outcomes were ascertained by chart review and telephone follow-up with mothers.

Five first trimester losses were observed in 18 hCG confirmed pregnancies for a loss rate of 28%. Thirteen pregnancies produced apparently normal babies. One normal fetus was lost at 20 weeks' gestation because of cervical incompetence.

There does not appear to be an increased risk of birth defects or pregnancy wastage in human pregnancies exposed to daily low-dose GnRH-a therapy in the first weeks of gestation.