No significant leukocytosis under controlled ovarian stimulation using the LHRH antagonist Cetrorelix and recFSH

Pregnancy-induced leukocytosis: A case report

BACKGROUND

Pregnancy is a complex physiological process. Physiological leukocytosis occurs often and is mainly associated with increased neutrophil counts, especially in the third trimester of pregnancy. Non-congenital leukocytosis with white blood cell counts above 20 × 10⁹/L lasting 13 wk during pregnancy is rare and has been reported occasionally. Herein, we present a case of pregnancy-induced leukocytosis.

CASE SUMMARY

We present the case of a 33-year-old Chinese woman at 27 wk of gestation who had a leukocytosis complication. No abnormalities were detected in the examinations before pregnancy or in the first trimester. From the third trimester of pregnancy, the patient began to suffer from asymptomatic leukocytosis. We administered antibiotics to treat the patient; however, the complication persisted until the patient underwent a cesarean section after 40⁺³ wk of gestation. One day after the cesarean section, the patient’s neutrophil count returned to normal. After 2 years of follow-up, we found that the patient and baby were healthy.

CONCLUSION

Pregnancy-induced leukocytosis seems to be associated with immunoregulation and pregnancy termination may be the most effective treatment approach for pregnancies complicated with malignant leukocytosis.

GnRH antagonists

Ovarian stimulation is an important step in the success rate of in vitro fertilization (IVF) allowing multiple follicular growth, several oocytes and consequently more embryos. The combination of GnRH-antagonists (GnRH-ant) and gonadotrophins is now available for clinical use and represent a valid alternative to classical protocol with GnRH agonist. GnRH-antagonists induce a direct block of GnRH receptor with a rapid decrease in LH and FSH, preventing LH surge. Two protocols has been designed for assisted reproduction technology (ART) treatment: multiple-dose protocol and a single-dose. Both protocols are simply, efficacious, started in the late follicular phase and do not have side effects. A review of GnRH-antagonist applications in ART cycles are presented. Smaller doses of gonadotrophins, shorter stimulation period and lower ovarian hyperstimulation syndrome (OHSS) incidence are reported in literature using GnRH-antagonist compared to agonist. Triggering of ovulation, the use in polycystic ovarian syndrome (PCOS) and poor reponders patients are other interesting indication. Regarding to pregnancy rate and potentially adverse effects of drugs on endometrium or implantation needed more data.

Effect of ovaric hyper-stimulation on blood lymphocyte subpopulations, cytokines, leptin and nitrite among patients with unexplained infertility

PROBLEM

To determine the effect of ovarian stimulation on TH1, TH2 and natural killer (NK) lymphocytes, plasma cytokines, leptin and nitrite levels.

METHODS

Women with reproductive failure were studied during the implantation window, at baseline (n = 18) and under ovarian stimulation (gonadotropins + progesterone, n = 6).

CONTROLS

eight fertile women. Lymphocyte subpopulations and NK function were determined by flow cytometry. Interleukin-2 (IL-2), IL-4, IL-10, IFN-gamma, TNF-alpha, TGF-beta1 and leptin were measured by enzyme immunoassay (EIA); nitrite by the Griess reaction.

RESULTS

At baseline, patients had higher values of NK effectors, NK activity and plasma IFN-gamma and IL-2 than controls. Conversely, TGF-beta1 values were lower. Hormones induced leukocytosis. Under stimulation, THI CD4+ cells, NK effectors and function and plasma IFN-gamma and IL-2 decreased, while transforming growth factor (TGF)-beta1 increased. Other variables did not change.

CONCLUSION

The abnormal distribution of leukocytes, high TH1 cytokines and a low TGF-beta1 associated with reproductive failure, respond to ovarian stimulation, achieving total or partial normalization.