Abstract
BackgroundPrior reports suggest a link between gonadotropin-releasing hormone (GnRH) and gastrointestinal function. The aim of the study was to prospectively investigate women subjected to in vitro fertilization (IVF) using the GnRH analog buserelin, taking into account gastrointestinal symptoms and antibody development against buserelin, GnRH, luteinizing hormone (LH), and their receptors.MethodsGastrointestinal symptoms were registered by the Visual Analogue Scale for Irritable Bowel Syndrome (VAS-IBS) before and after IVF treatment, and five years later. Health-related quality of life was evaluated by the 36-item Short-Form questionnaire (SF-36). ELISA was used for antibody analyses before and after treatment. Data were compared with women from the general population.ResultsIn total, 124 patients were investigated before and after IVF, and 62 were re-evaluated after five years. Buserelin treatment led to significant impairment of constipation (p = 0.004), nausea and vomiting (p = 0.035), psychological well-being (p = 0.000), and the intestinal symptoms’ influence on daily life (p = 0.027). At 5-year follow-up, abdominal pain was worsened (p = 0.041), but psychological well-being was improved (p = 0.036), compared to prior treatment, and 15% had an observable deterioration in gastrointestinal symptoms. None developed severe dysmotility. Patients had higher prevalence of IgG antibodies against LH (p = 0.001) and its receptor (p = 0.016), and IgM antibodies against the GnRH receptor (p = 0.001) prior treatment compared with controls, but no antibody development was observed after IVF.ConclusionPatients experience gastrointestinal symptoms during buserelin treatment, and abdominal pain is still increased after five years, but buserelin does not increase antibody formation against GnRH, LH or their receptors.
Highlights
Prior reports suggest a link between gonadotropin-releasing hormone (GnRH) and gastrointestinal function
As in vitro fertilization (IVF) is given repeatedly to young women, the same population which is most likely to be affected by gastrointestinal symptoms and dysmotility [1], and sporadic cases of severe dysmotility have been reported after IVF [7,11], we found it important to examine possible connections between IVF and Irritable bowel syndrome (IBS) or dysmotility in an IVF cohort
Forty percent of the women were subjected to IVF treatment for the first time, 24% had IVF treatment for the second time, 23% for the third time, and 14% had had four or more treatments when investigated
Summary
Prior reports suggest a link between gonadotropin-releasing hormone (GnRH) and gastrointestinal function. Chronic intestinal pseudo-obstruction (CIPO) was developed after repeated treatment with the GnRH analog buserelin in the setting of in vitro fertilization (IVF). Scrutiny of 22 patients who had undergone fullthickness biopsy due to severe, gastrointestinal motility disorders, i.e. CIPO or enteric dysmotility (ED), revealed five patients with lowered levels of enteric GnRH-containing neurons and elevated levels of serum antibodies against GnRH. Three of these five had had repeated treatments with GnRH analogs in an IVF setting and/or due to endometriosis [7]. Repeated buserelin treatment of rats led to 50% loss of enteric neurons [12]
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