Gonadorelin

Clinical outcomes of combining recombinant follicle-stimulating hormone (rFSH) with highly purified human menopausal gonadotropin (HP-hMG) versus rFSH alone were compared in patients undergoing in vitro fertilization in a real-world setting. This retrospective cohort study analyzed patients who underwent ovarian stimulation with rFSH or rFSH + HP-hMG following a gonadotropin-releasing hormone antagonist protocol, followed by fresh or frozen embryo transfer (ET) at two centers in Korea. A total of 1,028 women were included: 329 underwent fresh ET (rFSH: n = 78; rFSH + HP-hMG: n = 251) and 699 underwent frozen ET (rFSH: n = 250; rFSH + HP-hMG: n = 449). Across both fresh and frozen ET group, patients receiving rFSH + HP-hMG were older and had lower anti-Müllerian hormone levels and antral follicle counts. Despite fewer oocytes retrieved in rFSH + HP-hMG group (fresh: 9.5 vs. 11.0; frozen: 16.3 vs. 20.6, both p < 0.05), metaphase II oocyte rates and clinical pregnancy rates were comparable (fresh: 44.6 vs. 43.6%; frozen: 58.4 vs. 56.8%, both p > 0.05). Notably, ovarian hyperstimulation syndrome incidence was significantly lower in rFSH + HP-hMG group among frozen ET patients (6.9 vs. 13.2%, p < 0.01). These findings suggest that rFSH + HP-hMG achieves comparable clinical outcomes to rFSH alone despite less favorable prognostic characteristics that could affect clinical outcome, supporting its role as a clinically acceptable alternative stimulation option in routine practice.

BACKGROUND: Ovarian hyperstimulation syndrome is a potentially serious complication of fertility treatments. Standard care often involves monitoring, then hospitalisation for severe cases. Some evidence suggests early outpatient paracentesis may prevent hospitalisation, but adequately powered randomised trials are lacking. OBJECTIVES: To establish the clinical and cost-effectiveness, safety and acceptability of early active outpatient management for moderate or severe ovarian hyperstimulation syndrome. DESIGN AND METHODS: A pragmatic, parallel, open-label, multicentre, superiority, adaptive, group sequential randomised controlled trial with an internal pilot was planned. The study included preliminary qualitative work and a post-trial survey. The main trial recruited participants with moderate or severe, early or late ovarian hyperstimulation syndrome from UK fertility clinics. Participants were randomised 1 : 1 to receive either outpatient paracentesis or usual care (conservative management). The primary outcome was ovarian hyperstimulation syndrome-related hospital admission within 28 days. RESULTS: The trial was terminated early due to poor recruitment. Only 8 participants were randomised (5 to conservative management, 3 to outpatient paracentesis) across 3 of 9 opened sites, compared to the planned 224 participants. All eight had moderate ovarian hyperstimulation syndrome at baseline. Two participants were hospitalised for ovarian hyperstimulation syndrome-related reasons (one from each group). Six participants' symptoms resolved during follow-up, while two had unknown outcomes. There were no reported serious adverse events caused by the intervention. The post-trial survey of 16 fertility centres found increased use of preventive measures like freeze-all cycles, antagonist protocols and gonadotropin-releasing hormone trigger, during and after the SARS-CoV-2 (COVID-19) pandemic. LIMITATIONS: The small sample size precludes drawing any definitive conclusions about effectiveness, safety or cost-effectiveness. The study was severely impacted by the COVID-19 pandemic, affecting site set-up and recruitment, and changes in clinical practice during the pandemic may have reduced ovarian hyperstimulation syndrome cases. CONCLUSIONS: No definitive clinical conclusions can be drawn from this study about the effectiveness of outpatient management compared to conservative management. The pandemic prompted lasting modifications in ovarian hyperstimulation syndrome prevention strategies at many fertility clinics. FUTURE WORK: Given the observed low incidence rates of ovarian hyperstimulation syndrome and challenges in recruitment, future research may need to consider alternative study designs in observational settings rather than randomised trials that reflect the changing reality of clinical management and prevention of ovarian hyperstimulation syndrome, particularly following the recent COVID pandemic. Additionally, the research community should reflect on strategies to improve trial resilience and adaptability in the face of major disruptions like pandemics. FUNDING: This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number NIHR128137.

RATIONALE: Adenomyosis and simple endometrial hyperplasia are common benign gynecological conditions. However, atypical presentations with extreme endometrial thickening and associated diagnostic challenges have rarely been reported. PATIENT CONCERNS: A 27-year-old woman presented with a 13-year history of menstrual irregularity and endometrial thickness of 7.0 cm on ultrasonography. Magnetic resonance imaging (MRI) revealed an enlarged uterus and a 7.9 cm intrauterine mass (T1 isointense, T2 hyperintense, diffusion-weighted imaging high signal) with junctional zone interruption. INTERVENTIONS: Taking into account the patient's reproductive needs and the fact that hysteroscopy couldn't completely remove the contents of the uterine cavity, an open surgery was used for diagnosis and treatment. DIAGNOSES: Pathological examination led to the diagnosis of adenomyosis combined with non-atypical endometrial hyperplasia. OUTCOMES: After 6 months of postoperative gonadotropin-releasing hormone agonist (GnRH-a) treatment, the patient achieved regular menstruation. During 10 years of follow-up, she had 2 natural pregnancies and delivered 2 full-term infants via cesarean section. LESSONS: This case highlights that adenomyosis can present with an extremely thickened endometrium, an intrauterine mass and the absence of typical dysmenorrhea. Combined surgery and GnRH-a can achieve long-term symptom control and successful pregnancies, supporting fertility-preserving management in similar young patients.

This study aimed to conduct computer searches in PubMed, Web of Science, Embase, the Cochrane Library, CNKI, VIP, Wanfang, and CBM databases. Literature was screened and data extracted according to the inclusion and exclusion criteria. RevMan 5.3 was used to assess the methodological quality of the included studies, while Stata 14.0 was employed to rank the efficacy and safety of the five interventions. This analysis included 20 randomised controlled trials involving a total of 2,400 patients. The cumulative probability ranking results showed that, for improving clinical pregnancy rate (CPR), leuprorelin (97.8%) ranked highest, followed by cetrorelix (70.7%), triptorelin (47.9%), buserelin (18.2%), and ganirelix (15.3%). For improving the live birth rate (LBR), leuprorelin (99.9%) ranked highest, followed by triptorelin (44.1%) and cetrorelix (5.9%). For reducing the incidence of ovarian hyperstimulation syndrome (OHSS), cetrorelix (96.9%) ranked highest, followed by buserelin (58.7%), ganirelix (57.5%), leuprorelin (21.2%), and triptorelin (15.7%). Cetrorelix demonstrated superior performance in reducing the risk of OHSS, while leuprorelin was more effective in improving CPR and LBR. For women with polycystic ovary syndrome at high risk of OHSS, cetrorelix is recommended. For patients with the primary goal of improving CPR or LBR, leuprorelin is the more appropriate choice. Key Words: Polycystic ovary syndrome, Infertility, GnRH agonist, GnRH antagonist, Assisted reproduction.

BACKGROUND: Kallmann syndrome (KS) is a rare congenital disorder characterized by hypogonadotropic hypogonadism secondary to deficient gonadotropin-releasing hormone (GnRH) secretion, often accompanied by partial or complete anosmia. Deficient GnRH secretion results in decreased levels of follicle-stimulating hormone (FSH) and luteinizing hormone (LH), causing impaired sexual development and absent secondary sexual characteristics. Against the backdrop of global expansion in rare disease research, KS has become a core research focus, and a comprehensive bibliometric analysis is required to chart the trajectory, trends, hotspots, and future paths in KS research over the last 15 years. METHODS: A systematic search of the Web of Science Core Collection (WOSCC) retrieved KS publications from January 1, 2009, to August 18, 2025, employing the search term "Kallmann syndrome" with the language restricted to English and no restrictions imposed on publication types. Data analyses were performed using VOSviewer for visualizing collaborative networks, CiteSpace for bursts and clusters, and R for statistics, to evaluate publication trends, countries, institutions, authors, journals, citations, and keywords. RESULTS: KS publications exhibited steady double-digit annual growth, reaching 508 studies. The U.S. ranked first in publication volume, followed by Switzerland and France. Nelly Pitteloud (Switzerland) and Jacques Young (Paris Public Hospitals) were the most prolific and influential authors. The Journal of Clinical Endocrinology and Metabolism published the largest number of KS-related articles; Harvard University was the leading contributing institution. The most highly cited article, "Expert Consensus: European Consensus Statement on Congenital Hypogonadotropic Hypogonadism-Pathogenesis, Diagnosis and Treatment," was cited 575 times in total. Keywords identified hotspots like GnRH deficiency, hypogonadotropic hypogonadism, anosmia, and genetic mutations (> 30 genes), current research frontiers focusing on molecular pathogenesis and personalized therapies. CONCLUSIONS: Our study provided a comprehensive overview of Kallmann syndrome research and showed the development status and scientific trend of Kallmann syndrome through bibliometric analysis from 2009 to 2025. The global volume of publications related to Kallmann syndrome has demonstrated a steady year-on-year increase. Research in this field is predominantly led by European and American countries, and cross-regional collaboration serves as a key driver for further advancement. In summary, these findings provide new perspectives for future relevant research and serve as a valuable reference to guide researchers in subsequent studies.