Ovarian hyperstimulation gonadotropins

Gonadotropins are used to treat infertility in women with potentially functional ovaries who have not responded to other treatments. The therapy is designed to simulate the normal menstrual cycle as far as is practical. A common protocol is daily injections of menotropins for 9 to 12 days, until estradiol levels are equal to that in a normal woman, followed by a single dose of hCG to induce ovulation. Two problems with this treatment are risks of ovarian hyperstimulation and of multiple births. Ovarian hyperstimulation is characterized by sudden ovarian enlargement associated with an increase in vascular permeability and rapid accumulation of fluid in peritoneal, pleural, and pericardial cavities. To prevent such occurrences, ovarian development is monitored during treatment by ultrasound techniques and by measurements of serum levels of estradiol. 

G. Other applications Limited data show some beneficial effects of leuprolide in the treatment of breast cancer. According to Micromedex, there is good documentation that leuprolide is effective for bowel pain and nausea associated with irritable bowel syndrome. Leuprolide has been used for controlled ovarian hyperstimulation to enhance the in vitro fertilization-embryo transfer procedure. In endometriosis, the goal of treatment is pain relief and reduction of endometriotic lesions. In children with central precocious puberty, stimulated and basal gonadotropins are reduced to prepubertal levels. Testosterone and estradiol are reduced to prepubertal levels in males and females, respectively. 

In women treated with gonadotropins and hCG, the two most serious complications are the ovarian hyperstimulation syndrome and multiple pregnancies. Overstimulation of the ovary during ovulation induction often leads to... 

SUPPRESSION OF GONADOTROPIN PRODUCTION Controlled Ovarian Hyperstimulation... 

While it is possible that the gonadotropins themselves induced SIADH, it seems more likely that it was a secondary complication of ovarian hyperstimulation. 

A 33-year-old woman developed severe symptomatic ovarian hyperstimulation after being given 10 000 IU of urinary human chorionic gonadotropin for empty follicle syndrome (22). 

Urine-derived urofollitropin and recombinant FSH appear to be equally effective and well tolerated for induction of ovulation (34). However, it is unclear whether human menopausal gonadotropins have a higher risk of overstimulation and ovarian hyperstimulation syndrome than urofollitropin in women with polycystic ovary syndrome. 

A generalized allergic reaction to human menopausal gonadotropin (Pergonal) has been described during controlled ovarian hyperstimulation (40). In this case a desensitization protocol allowed the patient to complete her treatment cycle without further problems. Subsequently recombinant follicle stimulating hormone was used successfully and uneventfully. 

Shapiro BS, Daneshmand ST, Garner FC, Aguirre M, Ross R, Morris S. Effects of the ovulatory serum concentration of human chorionic gonadotropin on the incidence of ovarian hyperstimulation syndrome and success rates for in vitro fertilization. Fert Steril 2005 84 93-8. 

Watanabe T. Early prediction of ovarian hyperstimulation syndrome during gonadotropin therapy by means of a damped oscillation rheometer. Biorheology 2002 39 767-86. 

A 32-year-old woman who was not obese developed benign intracranial hypertension in association with ovarian hyperstimulation syndrome after ovulation induction using goserelin, follitropin, and human chorionic gonadotropin (hCG) (3). The syndrome did not recur during a second pregnancy in which follitropin and hCG were not used... 

Jirecek S, Nagele F, Huber JC, Wenzl R. Ovarian hyperstimulation syndrome caused by GnRH-analogue treatment without gonadotropin therapy in a patient with polycystic ovarian syndrome. Acta Obstet Gynecol Scand 1998 77(9) 940-1. 

CIO. Copperman, A. B., Horowitz, G. M., Kaplan, P., Scott, R. T., Navot, D., and Hofmann, G. E., Relationship between circulating human chorionic gonadotropin levels and premature luteinization in cycles of controlled ovarian hyperstimulation. Fertil. Steril. 63, 1267-1271 (1995). 

M6. McLachlan, R. I., Healy, D. L., and Robertson, D. M., Plasma inhibin levels during gonadotropin-induced ovarian hyperstimulation for IVF A new index of follicular function ... 

Clomiphene is used primarily for treatment of female infertility due to anovulation. By increasing gonadotropin levels, primarily FSH, it enhances follicular recruitment. It is relatively inexpensive, orally active, and requires less extensive monitoring than do other treatment protocols. However, the drug may exhibit untoward effects, including ovarian hyperstimulation, increased incidence of multiple births, ovarian cysts, hot flashes, and blurred vision. In addition, clomiphene-induced cycles have a relatively high... 

Recombinant preparations of gonadotropins increasingly are used in clinical practice. The two rFSH preparations that are available (follitropin a [gonal-f] and follitropin j3 [puregon, follistim]) both exhibit less interbatch variability than do preparations purified from urine and can be administered subcutaneously, since they are considerably purer. The relative advantages of the recombinant preparations (i.e., efficacy, lower frequency of side effects such as ovarian hyperstimulation) have not been definitively established despite much debate in the published literature. 

E. Luteinizing Hormone (LH) LH is the major stimulant of gonadal steroid production. In women, LH also regulates follicular development and ovulation. No pure preparation of LH is currently in use. Human chorionic gonadotropin (hCG), which has an almost identical structure, is used in place of LH for treatment of hypogonadism in men and women and as part of controlled ovarian hyperstimulation and assisted reproductive technology programs. 

Menotropins (Pergonol) Menotropins are LH and FSH (purified from urine of postmenopausal women) which are administered intramuscularly for 9-12 days and followed by an injection of chorionic gonadotropin. Multiple births occur in 20% of menotropin-induced pregnancies. Ovarian hyperstimulation, hemoperitoneum, febrile reactions and arterial thromtoembolism are the most frequent undesirable effects. 

Theca lutein cysts are ovarian cysts that are lined by luteinized theca cells. They develop in patients with high levels of serum human chorionic gonadotropin. They are not as common as other ovarian cysts. They are associated with multiple gestations, trophoblastic disease, and pregnancies comphcated by hydrops fetalis, or in ovarian hyperstimulation syndrome. 

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