THE HORMONAL PROFILE IN WOMEN AT HIGH RISK FOR OVARIAN HYPERSTIMULATION SYNDROME AFTER REPLACEMENT OF AN OVULATION TRIGGER

Objective. To study the time course of changes in the concentrations of sex hormones in the serum and follicular fluid of patients at high risk for ovarian hyperstimulation syndrome (OHSS) when replacing an ovulation trigger and during different variants of luteal phase support. Subjects and methods. The investigation enrolled 134 patients aged 20 to 39 years at high risk for OHSS. The patients were divided into three groups according to the injected ovulation trigger: 1) gonadotropin-releasing hormone (GnRH) agonist (GnRH-α) 0.2 mg (n = 48); 2) GnRH-α 0.2 mg in combination with human chorionic gonadotropin (hCG) 1500 IU (n = 45); 3) hCG 10,000 IU (n = 41). Micronized progesterone 600 mg/day and estradiol valerate 4 mg/day were used for luteal phase support in Groups 1 and 2. In Group 1, hCG was additionally injected in a dose of 1500 IU for luteal phase support on the day of transvaginal puncture (TVP). In Group 3, micronized progesterone was administered in a dose of 600 mg/day for luteal phase support. To estimate the concentrations of luteinizing hormone (LH), estradiol, and progesterone, peripheral blood was sampled on the days of ovulation triggering and TVP and on days 3 and 5 after TVP. The follicular fluid hormonal profile was determined in 66 patients: 23 women in Group 1, 23 women in Group 2, and 20 women in Group 3. Results. Analysis of the hormonal profile of the examined groups revealed that LH concentrations were statistically higher in the GnRH-α and GnRH-α + hCG groups than those in the hCG group. Estradiol on day 3 following TVP was statistically significantly higher in the GnRH-α group than in the hCG group whereas that on day 5 statistically significantly reduced in the GnRH-α + hCG group than in Groups 1 and 3. There was a statistically significant decrease in progesterone concentrations on day 5 after TVP in the GnRH-α + hCG group than in the Groups 1 and 3. In the GnRH-α group, progesterone concentrations on days 3 and 5 following TVP were comparable with those in the hCG group. The incidence of mild OHSS was 16.7% in Group 1, 27.3% in Group 2, and 36.6% in Group 3. In the GnRH-α group, all cases belonged to late OHSS that occurred during conception. No matter what ovulation trigger was used, the embryological parameters were identical in all the examined groups. There were no statistically significant differences in the rate of conception after embryo transfer and in that of pregnancy termination in all the groups. Conclusion. Modified support of the luteal phase effectively correlates its failure after replacement of an ovulation trigger, which enables effective prevention of OHSS, without having any impact on the rate of conception.

ovarian hyperstimulation syndrome, ovulation trigger replacement, progesterone, estradiol, luteinizing hormone, luteal phase, gonadotropin-releasing hormone agonist, in vitro fertilization