Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 26, 2023; 11(9): 2067-2073
Published online Mar 26, 2023. doi: 10.12998/wjcc.v11.i9.2067
Live births from in vitro fertilization-embryo transfer following the administration of gonadotropin-releasing hormone agonist without gonadotropins: Two case reports
Mai Li, Ping Su, Li-Ming Zhou
Mai Li, Li-Ming Zhou, Reproductive Center, Ningbo Women and Children’s Hospital, Ningbo 315000, Zhejiang Province, China
Ping Su, Reproductive Center, Institution of Reproductive Health, Tongji Medical College, Wuhan 430030, Hubei Province, China
Author contributions: Li M contributed significantly to case collections and analysis and wrote the manuscript; Zhou LM contributed to the conception of the study; Su P contributed to manuscript preparation.
Informed consent statement: Informed written consent was obtained from the patients.
Conflict-of-interest statement: The authors declare having no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Li-Ming Zhou, BMed, Chief Physician, Reproductive Center, Ningbo Women and Children’s Hospital, No. 339 Liuting Street, Ningbo 315000, Zhejiang Province, China.
Received: December 13, 2022
Peer-review started: December 13, 2022
First decision: January 20, 2023
Revised: March 1, 2023
Article in press: March 1, 2023
Published online: March 26, 2023

The prevalence of female infertility between the ages of 25 and 44 is 3.5% to 16.7% in developed countries and 6.9% to 9.3% in developing countries. This means that infertility affects one in six couples and is recognized by the World Health Organization as the fifth most serious global disability. The International Committee for Monitoring Assisted Reproductive Technology reported that the global total of babies born as a result of assisted reproductive technology procedures and other advanced fertility treatments is more than 8 million. Advancements in controlled ovarian hyperstimulation procedures led to crucial accomplishments in human fertility treatments. The European Society for Human Reproduction and Embryology guideline on ovarian stimulation gave us valuable evidence-based recommendations to optimize ovarian stimulation in assisted reproductive technology. Conventional ovarian stimulation protocols for in vitro fertilization (IVF)–embryo transfer are based upon the administration of gonadotropins combined with gonadotropin-releasing hormone (GnRH) analogues, either GnRH agonists (GnRHa) or antagonists. The development of ovarian cysts requires the combination of GnRHa and gonadotropins for controlled ovarian hyperstimulation. However, in rare cases patients may develop an ovarian hyper response after administration of GnRHa alone.


Here, two case studies were conducted. In the first case, a 33-year-old female diagnosed with polycystic ovary syndrome presented for her first IVF cycle at our reproductive center. Fourteen days after triptorelin acetate was administrated (day 18 of her menstrual cycle), bilateral ovaries presented polycystic manifestations. The patient was given 5000 IU of human chorionic gonadotropin. Twenty-two oocytes were obtained, and eight embryos formed. Two blastospheres were transferred in the frozen-thawed embryo transfer cycle, and the patient was impregnated. In the second case, a 37-year-old woman presented to the reproductive center for her first donor IVF cycle. Fourteen days after GnRHa administration, the transvaginal ultrasound revealed six follicles measuring 17-26 mm in the bilateral ovaries. The patient was given 10000 IU of human chorionic gonadotropin. Three oocytes were obtained, and three embryos formed. Two high-grade embryos were transferred in the frozen-thawed embryo transfer cycle, and the patient was impregnated.


These two special cases provide valuable knowledge through our experience. We hypothesize that oocyte retrieval can be an alternative to cycle cancellation in these conditions. Considering the high progesterone level in most cases of this situation, we advocate freezing embryos after oocyte retrieval rather than fresh embryo transfer.

Keywords: Gonadotropin-releasing hormone agonist, Ovarian hyperstimulation, In vitro fertilization, Live birth, Infertility, Frozen-thawed embryo transfer, Human chorionic gonadotropin, Case report

Core Tip: Gonadotropin-releasing hormone agonist (GnRHa) is administered in the ‘long protocol’ regimen for pituitary downregulation in vitro fertilization-embryo transfer. The development of ovarian cysts requires gonadotropin administration after pituitary downregulation in the long protocol. However, our cases presented an extremely special condition that a very small group of patients can develop called ovarian hyperstimulation receiving GnRHa alone. It is extremely rare that both patients had a successful egg retrieval during their first in vitro fertilization cycle and were impregnated. These cases provide some experience for clinical judgment and a new insight into the possible mechanisms of GnRHa action without gonadotropins.