Is the Use of a Gnrh Antagonist Effective in Patients with Polycystic Ovarian Syndrome? A South African Perspective (Original Article) (Gonadotrophin-Releasing Hormone) (Report‪)‬

At least 25% of couples experience some delay in achieving a desired or planned pregnancy, and 10% remain involuntarily childless before seeking medical assistance. (1) Ovulatory dysfunction and tubal and peritoneal factors are prevalent at all ages, and male factors and unexplained causes are more common in older couples. (2) Anovulation and oligo-ovulation account for approximately 40% of female infertility factors, and in this group polycystic ovarian disease (PCOS) is the predominant factor (80%). (3,4) A definite diagnosis of PCOS can be made in 70-80% of anovulatory infertility. (5) Standardised diagnostic criteria for PCOS have been accepted following a consensus meeting in Rotterdam in 2003. (6) Induction of ovulation for the purposes of infertility management in the typical PCOS patient with concomitant metabolic syndrome should be preceded by weight loss and lifestyle modification. Clark et al. and Norman et al. found that 90% of patients who lost 5% or more of body weight returned to ovulation, with 60% becoming pregnant within 18 months. (7,8) Insulin sensitisation using drugs such as metformin, a biguanide, has been used as both an adjunct and an alternative to clomiphene citrate in patients who are not successful in achieving ovulation or pregnancy. (9-11) A recent review concluded that metformin is highly effective in achieving ovulation in the clomiphene citrate-resistant PCOS patient, but should not be used as a first-line treatment modality. (12) In vitro fertilisation (IVF) technology is an effective treatment option after repeated ovulation induction failure using clomiphene citrate and gonadotrophin therapy. The initial gonadotrophin-releasing hormone (GnRH) analogues used in controlled ovarian stimulation were the GnRH agonists. Problems caused by GnRH agonists were mid-cycle gonadotrophin flares, a high incidence of multiple pregnancies and ovarian hyperstimulation syndrome (OHSS). (13)