{"paper_id":"9d02ed98-d1c1-4912-ba3b-b67ea3ebe56d","body_text":"Case Report\nObstetrics and Gynecology Reports\nObstet Gynecol Rep, 2019          doi: 10.15761/OGR.1000140\n Volume 3: 1-2\nISSN: 2515-2955\nControlled ovarian stimulation and oocyte retrieval under \ncontinuous administration of Dienogest in a patient with \ncatamenial pneumothorax\nTsuyoshi Takiuchi*, Mika Handa, Tatsuya Miyake and Tadashi Kimura\nDepartment of Obstetrics and Gynecology Graduate School of Medicine, Osaka University, Japan\nAbstract\nBackground: Catamenial pneumothorax (CP) is a rare disease that accompanies recurrent pneumothorax in conjunction with menstrual cycles and is presumed to \nbe caused by endometriosis. Dienogest, a selective progesterone receptor agonist, has been used as the long-time treatment for endometriosis. However, the effect of \ndienogest on oocyte growth during controlled ovarian stimulation (COS) remains unclear. \nCase: We present the case of a 40-year-old nulliparous, infertile woman with CP who underwent COS and oocyte retrieval under continuous administration of \ndienogest.\nConclusion: Our experience suggests that continuous administration of dienogest during COS is effective for the prevention of CP recurrence without impairing \nthe outcome of COS.\n*Correspondence to: Tsuyoshi Takiuchi, Department of Obstetrics and \nGynecology Graduate School of Medicine, Osaka University, Japan, Tel: 81-6-\n6879-3356; Fax: 81-6-6879-3359; E-mail: takkitakktakki@gyne.med.osaka-u.ac.jp\nKey words: dienogest, controlled ovarian stimulation, catamenial pheumothorax\nReceived: December 05, 2019; Accepted: December 12, 2019; Published: \nDecember 16, 2019\nAbbreviations: CP: Catamenial pneumothorax; COS: Controlled \novarian stimulation\nIntroduction \nCatamenial pneumothorax (CP) is a rare disease that accompanies \nrecurrent pneumothorax in conjunction with menstrual cycles and is \npresumed to be caused by endometriosis [1]. The standard treatment \nfor CP is multidisciplinary, consisting of surgical treatment and \nhormone therapy. Dienogest, a selective progesterone receptor agonist, \nhas been used as the long-time treatment for endometriosis [2]. \nHowever, the effect of dienogest on oocyte growth during controlled \novarian stimulation (COS) remains unclear, and few cases about COS \nunder continuous administration of dienogest have been reported. \nHere, we report a case of COS and oocyte retrieval under continuous \nadministration of dienogest in an infertile woman with CP .\nCase report\nA 40-year-old nulliparous, infertile woman with an Anti-Müllerian \nHormone (AMH) value of 1.44 ng/mL was referred to our hospital \nfor infertility treatment. Six years ago, she experienced a right-sided \npneumothorax during her menstrual cycle and five episodes of \nrecurrent right-sided pneumothorax during menstrual cycles for \nsubsequent seven months, followed by thoracoscopic surgery. She was \nstrongly suspected to have CP , according to her clinical history and \noperative findings, including many holes in the diaphragm, although \nthe histopathology did not clearly reveal endometrial tissue in the \nresected specimen. No recurrence of CP had been observed since the \nadministration of dienogest 2 mg daily after the surgery.\nBased on a consultation with the Department of Thoracic Surgery \nin our hospital, continuation of dienogest during the infertility \ntreatment was recommended, weighing the increased risk of recurrence \nof CP due to the withdrawal of dienogest. Therefore, we chose random-\nstart ovarian hyperstimulation under continuous administration of \ndienogest to retrieve twelve oocytes, seven of which were metaphase \nII oocytes (Figures 1 and 2). Finally, three day 3 embryos and one \nblastocyst were cryopreserved. She did not suffer from CP during or \nafter COS.\nDiscussion\nCP is a rare disease, but it may be underdiagnosed. A report \nindicated that it is more frequent than expected because it was diagnosed \nin almost 25% of women who had undergone surgical treatment with \nspontaneous pneumothorax [1]. The clinical presentations and possible \nassociated predictive factors have not been described in detail. Pelvic \nendometriosis was found in 51% of women with CP , and infertility and \nuterine procedures are significantly associated with CP , although the \nrelationship between endometriosis and infertility has already been \nrecognized [3]. Lalani et al. reported that dienogest may be an effective \nhormonal treatment option and alternative to long-term GnRH agonist \ntherapy for women with recurrent CP [4].\nDienogest, a selective progesterone receptor agonist, has \nbeen widely used for the treatment of endometriosis in women of \nreproductive age who may suffer from infertility [2]. Therefore, it is not \nrare to treat infertile patients with dienogest, but there has been some \n\nTakiuchi T (2019) Controlled ovarian stimulation and oocyte retrieval under continuous administration of Dienogest in a patient with catamenial pneumothorax\n Volume 3: 2-2\nObstet Gynecol Rep, 2019          doi: 10.15761/OGR.1000140\nconcern that the local effects of dienogest may have a direct impact on \nfollicular maturation or that the systemic levels may be high enough to \naffect ovarian stimulation. The effect of dienogest on COS has not been \nreported yet, although other progestins have been studied. A study to \nevaluate differences in ovarian stimulation outcomes in women using a \nlevonorgestrel-releasing intrauterine device (LNG-IUD) demonstrated \nthat LNG-IUDs do not affect cycle performance, including total oocyte \nor mature oocyte yields, in women undergoing ovarian stimulation \ncycles [5]. Kuang, et al. showed that in the medroxyprogesterone acetate \n(MPA) group (progestin primed ovarian stimulation), the number of \noocytes retrieved, and mature oocytes was similar to that in the short \nprotocol group for women undergoing COS [6]. These data about \nother progestins do not indicate adverse effects related to dienogest \nwith respect to reproductive outcomes. However, dienogest should \nnot be continued unless its necessity during COS has been assessed \nby a multidisciplinary team. Although there are no factors to predict \nthe recurrence of CP , the increased risk of recurrence of CP owing to \nthe withdrawal of dienogest should be considered. Our results showed \nthat the number of oocytes retrieved was sufficient despite the age and \nAMH value, although the proportion of immature oocytes was slightly \nhigher than usual. Further investigation is warranted.\nConclusion\nOur experience suggests that continuous administration of \ndienogest during COS was effective for the prevention of CP recurrence \nwithout impairing the outcomes of COS.\nFinancial support\nNone.\nReferences\n1. Alifano M, Roth T, Broët SC, Schussler O, Magdeleinat P, et al. (2003) Catamenial \npneumothorax: a prospective study. Chest 124: 1004-1008.\n2. Schindler AE (2011) Dienogest in long-term treatment of endometriosis. Int J Womens \nHealth 3: 175-184.\n3. Rousset-Jablonski C, Alifano M, Plu-Bureau G, Camilleri-Broet S, Rousset P, et al. \n(2011) Catamenial pneumothorax and endometriosis-related pneumothorax: clinical \nfeatures and risk factors. Hum Reprod 26: 2322-2329. \n4. Lalani S, Black A, Hodge MC, Tulandi T, Chen I (2017) Dienogest Therapy as a \nTreatment for Catamenial Pneumothorax: Case Report and Review of Hormonal \nOptions. J Obstet Gynaecol Can 39: 764-768. \n5. Adeleye AJ, Aghajanova L, Kao CN, Cedars MI, Sauer MV (2018) Impact of \nthe levonorgestrel-releasing intrauterine device on controlled ovarian stimulation \noutcomes. Fertil Steril 110: 83-88.\n6. Kuang Y , Chen Q, Fu Y , Wang Y , Hong Q, et al. (2015) Medroxyprogesterone acetate \nis an effective oral alternative for preventing premature luteinizing hormone surges in \nwomen undergoing controlled ovarian hyperstimulation for in vitro fertilization. Fertil \nSteril 104: 62-70.\nFigure 1. Treatment scheme for the random start protocol\nFigure 2. Transvaginal ultrasound showing both ovaries on day 10\nCopyright: ©2019 Takiuchi T. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted \nuse, distribution, and reproduction in any medium, provided the original author and source are credited.","source_license":"CC0","license_restricted":false}