The use of GnRH-nts in large series of polycystic ovarian syndrome (PCOS) patients has not been published so far. One of the most important hormonal aspects of PCOS patients is the increased LH tone secretion. This group of patients is characterized by anovulation, and ovarian ovulation induction is usually performed using clomiphene citrate, FSH associated or not with GnRH agonists. The rationale for the use of GnRH-nt in PCOS patients is the fact that the LH/FSH ratio will be decreased since LH secretion is more affected by the antagonist administration than FSH secretion (2). In IVF, another clear advantage is the reduced incidence of OHSS with the utilization of GnRH-nt. The use of GnRH-nt protocol allows also to induce the oocyte final maturation with GnRH agonist, to elicit an endogenous LH surge and, subsequently, decreasing the risk of OHSS (61). However, a large prospective trial is necessary to confirm these physiological hypotheses (see infra). Lubin et al. (62) described two case reports of PCOS patients treated with GnRH-nt before the treatment with GnRH agonist to induce ovulation. The patients showed a normalization of LH and testosterone serum levels, however, the authors failed to induce an appropriate ovarian response.
Two recent prospective randomized studies compared GnRH-nt to agonists in PCO patients (63,64). Those studies found similar pregnancy rate but failed to find a significant advantage to GnRH-nts.
Larger studies are needed to further evaluate the potential benefits of the association of GnRH-nt in PCOS patients.
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