cetrorelix and Hyperandrogenism

To determine whether the decrease in AMH levels during ovarian hyperstimulation for IVF occurs in patients with polycystic ovary syndrome (PCOS) and patients with low ovarian reserve (LOR), as in normal cycling women.. A cohort of 22 infertile patients treated in a single tertiary center with a GnRH-antagonist short protocol for IVF were prospectively included and divided into three groups: PCOS with hyperandrogenism (n=7), LOR (n=8) and control (n=7). Serum AMH levels were measured before and during FSH treatment, on the day of HCG administration, at the mid-luteal phase, and 14 days after embryo transfer. The three groups were compared using an ANOVA model in the case of continuous data and with Fisher's exact test when the data were discrete.. In the PCOS group, AMH levels increased at the beginning of the stimulation, but later decreased, until the mid-luteal stage. In the other two groups, AMH levels decreased throughout ovarian stimulation until the mid-luteal stage. In all groups, AMH levels returned to baseline levels two weeks after HCG administration, regardless of treatment outcome (pregnancy or not).. AMH levels decline during controlled ovarian hyperstimulation with a GnRH-antagonist short protocol in women with low and normal ovarian reserves. In contrast, in women with PCOS, an increase in AMH levels precedes this decline. These findings may support the hypothesis that androgens may play a role in AMH regulation in women.

Topics: Adult; Anti-Mullerian Hormone; Female; Fertilization in Vitro; Gonadotropin-Releasing Hormone; Humans; Hyperandrogenism; Infertility, Female; Luteal Phase; Ovarian Follicle; Ovarian Reserve; Ovulation Induction; Polycystic Ovary Syndrome

Conventional diagnostic procedures failed to provide a definitive diagnosis in a 15 year-old girl presenting with severe hirsutism, oligomenorrhea, and markedly elevated serum testosterone levels. To examine whether androgen overproduction was luteinizing hormone (LH) dependent and thus likely of ovarian origin we performed a new test to suppress LH secretion based on the use of Cetrorelix, a short-acting gonadotropin-releasing hormone antagonist. Subcutaneous administration of Cetrorelix 250 microg once daily for 5 days resulted in partial suppression of serum LH and testosterone. The same dose administered twice daily for 5 days almost completely suppressed serum LH and testosterone, thereby supporting a diagnosis of ovarian androgen excess. This observation was confirmed by a positive human chorionic gonadotropin stimulation test and an MRI showing bilateral polycystic ovaries.. The Cetrorelix suppression test appears to be a promising instrument to help solve the differential diagnosis of severe hyperandrogenism in adolescence.

Topics: Adolescent; Diagnosis, Differential; Diagnostic Tests, Routine; Female; Gonadotropin-Releasing Hormone; Hormone Antagonists; Humans; Hyperandrogenism; Injections, Subcutaneous; Luteinizing Hormone; Testosterone