Intranasal gonadotropin-releasing hormone agonist (GnRHa) for luteal-phase support following GnRHa triggering, a novel approach to avoid ovarian hyperstimulation syndrome in high responders

Objective: To study whether intranasal GnRH agonist (GnRHa) can be effectively used for luteal support in high-responder patients undergoing fresh-embryo transfer after ovulation induction with the use of GnRHa. Design: Retrospective cohort study. Setting: Private fertility clinic. Patient(s): Forty-six high-responder patients were administered a GnRHa ovulation trigger to avoid ovarian hyper-stimulation syndrome (OHSS), followed by 2 weeks of daily intranasal GnRHa (nafarelin) for luteal-phase support. No additional progesterone supplementation was administrated. Intervention(s): Intranasal GnRHa for luteal-phase support. Main Outcome Measure(s): The primary outcome was ongoing clinical pregnancy rate. Result(s): High median progesterone levels were measured at midluteal phase and on the day of the first positive pregnancy test (190 nmol/L on both measures). We obtained 24 (52.1%) ongoing clinical pregnancies. None of the patients developed OHSS. Conclusion(s): Intranasal GnRHa is effective in achieving luteal-phase support in high-responder patients triggered with GnRHa and avoiding OHSS. (C) 2016 by American Society for Reproductive Medicine.