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Is multiple pregnancy an unavoidable complication of ovulation induction? The case for pulsatile GnRH
M Filicori1, G E Cognigni, R Arnone
1Department of Obstetrics and Gynecology, University of Bologna, Italy.
Summary
Pulsatile gonadotropin-releasing hormone (GnRH) therapy effectively prevents ovarian hyperstimulation (OHS) and reduces multiple pregnancies during ovulation induction. Careful patient selection and hCG avoidance further minimize risks, achieving rates comparable to natural conception.
Area of Science:
- Reproductive endocrinology and infertility treatments.
Background:
- Ovarian hyperstimulation (OHS) and multiple pregnancies are significant risks associated with ovulation induction therapies.
- These complications can lead to adverse maternal and neonatal outcomes.
Purpose of the Study:
- To evaluate the efficacy of pulsatile gonadotropin-releasing hormone (GnRH) in preventing OHS and multiple pregnancies.
- To assess strategies for minimizing conception risks during ovulation induction.
Main Methods:
- Utilizing pulsatile GnRH administration for ovulation induction.
- Implementing low-dose GnRH, avoiding preovulatory human chorionic gonadotropin (hCG), and careful patient selection.
- Employing GnRH agonist pituitary desensitization in specific cases.
Main Results:
- Pulsatile GnRH therapy significantly prevents OHS.
- The described methods result in a low incidence of multiple pregnancies.
- Multiple conception rates were comparable to those in natural, unstimulated pregnancies.
Conclusions:
- Pulsatile GnRH is a safe and effective method for ovulation induction.
- Strategic management of ovulation induction protocols can minimize risks of OHS and multiple births.
- This approach offers a favorable risk-benefit profile for fertility treatments.