European Journal of Obstetrics & Gynecology and Reproductive Biology 80 (1998) 143–149 Triptorelin acetate administration in early pregnancy: case reports and review of the literature * Didier Chardonnens , Kirsten Sylvan, Dilys Walker, Paul Bischof, Denny Sakkas, Aldo Campana Department of Obstetrics and Gynecology, Clinic of Infertility and Gynecological Endocrinology, WHO Collaborating Center in Human Reproduction, University Hospital of Geneva, 32 Bvd de la Cluse, 1211 Geneva, Switzerland Received 22 January 1998; accepted 12 May 1998 Abstract When using a long protocol with cycle day 23 gonadotrophin-releasing hormone agonists (GnRH-a) administration, an elevated estradiol level or a missed period 10–14 days after initiating pituitary downregulation should alert the physician to the possibility of a pregnancy. We report 4 pregnancies occurring during pituitary downregulation with Triptorelin acetate in 366 in-vitro fertilization (IVF) cycles resulting in 3 deliveries of 4 normal neonates at term and 1 first trimester abortion. This supports published data reporting a 1% spontaneous pregnancy incidence in women undergoing pituitary desensitization GnRH-a during the luteal phase prior to planned IVF treatment, a 15.9% abortion rate and a 1.7% malformation rate. Our cases together with other published data suggest that pregnancy outcome is not adversely affected by GnRH-a administration during the luteal phase of the conception cycle. However, long term follow-up of these babies is still lacking and the number of reported cases is too small adequately to rule out the possibility of any detrimental effect related GnRH-a administration in pregnancy.  1998 Elsevier Science Ireland Ltd. All rights reserved. Keywords: GnRH agonist; Triptorelin acetate; Early pregnancy; IVF; Assisted reproduction 1. Introduction increases hMG requirements, significantly lowers cancella- tion rates because of premature LH surges [2] and in- Triptorelin acetate (Trpt) (Decapeptyl; Ferring A.G., creases the number of mature oocytes collected, therefore ¨ Dubendorf, Switzerland) is a synthetic gonadotrophin-re- improving the chances of oocyte fertilization and success- leasing hormone agonist (GnRH-a) characterized by the ful pregnancy [3–5]. substitution of glycine in position 6 by D-tryptophan. This Continuous GnRH-a exposure produces a transient rise increases its GnRH receptor affinity and its resistance to in gonadotrophin levels, the so called ‘flare up’, prior to enzymatic degradation. Two formulations of this agonist inducing a prolonged secondary hypogonadotropic state. can be used: a short acting daily formulation of 0.1 mg and This flare up can be minimized by beginning treatment in a 28-day long acting dose of 3.75 mg. the luteal phase when progesterone levels are elevated and Trpt, together with other GnRH-a, is used increasingly the probability of follicular recruitment is low. This in in-vitro fertilization (IVF) cycles in conjunction with reduces the incidence of ovarian cyst formation. There are, human Menopausal Gonadotrophins (hMG) [1]. Pituitary however, conflicting results in the literature [6]. The ‘long’ desensitization with GnRH-a prior to hMG stimulation protocol starting in the previous luteal phase appears to be more successful than the ‘short’ protocol beginning at the onset of menstruation, even though it requires higher doses * Corresponding author. Address for correspondence: Clinique de of hMG to achieve ovarian stimulation [5,7]. One potential ´ ´ ´ ˆ Sterilite et d’Endocrinologie Gynecologique, Hopital Cantonal Univer- drawback of luteal GnRH-a administration is that the ` ` sitaire de Geneve, 32 Bvd de la Cluse, 1211 Geneve, Switzerland. Fax: 0041 22 382 44 24; E-mail: chardonnens-didier@diogenes.hcuge.ch medication may be given inadvertently in a cycle in which 0301-2115 / 98 / $19.00  1998 Elsevier Science Ireland Ltd. All rights reserved. PII: S0301-2115(98)00109-2