Impact of baseline cysts at the time of administration of gonadotropin-releasing hormone analog for in vitro fertilization

Objective-To assess the effects of cysts developed prior to the commencement of luteal phase gonadotropin-releasing-hormone-agonist (GnRH-a) in IVF cycles. Design-Retrospective analysis. Setting-In vitro fertilization program in a tertiary hospital infertility clinic. Patients-Women stimulated for IVF-ET. All stimulations were down-regulated with GnRH-a commenced on day 21 in a long protocol before gonadotropin stimulation. Main Outcome Measure-Pregnancy rate. Results-Twenty-five of 121 cycles had cysts >15 mm (20.6%); these were classified as baseline (nonfunctional) (n = 12) or corpus luteum (n = 13) cysts. They had significantly longer suppression periods and lower peak estradiol levels, and used more gonadotropins during stimulation. Cysts had no impact on the number of oocytes collected or fertilization and pregnancy rates. Patients with baseline cysts had a greater duration of suppression and required more gonadotropin than those with corpus luteum cysts or those without cysts. The cycle outcomes were similar between the groups, but baseline cyst formation is likely to increase the cost of IVF. Conclusion-These findings suggest that baseline cyst formation causes longer suppression duration and greater gonadotropin utilization, although an impact on pregnancy rates is unlikely.