Of LH-R after buserelin treatment [12], and occurrence of serum antibodies against
Of LH-R after buserelin treatment [12], and occurrence of serum antibodies against LH and LH-R, suggest that LH and its receptor may be one plausible explanation to the connection between gut and genital organs observed in women [2,3,7,21]. Antibodies against FSH or its receptor were not analyzed as these peptides have not been detected in the digestive tract [39]. The current study has several limitations, where the most apparent is the loss of patients to follow-up, with a response rate of 49 after one reminder. Patients who have experienced side effects of the treatment could theoretically be more prone to return the questionnaire. On the contrary, the PubMed ID:https://www.ncbi.nlm.nih.gov/pubmed/28607003 patients who have got children after IVF are maybe not prone to report aggravated symptoms after the treatment. It would also have been preferable to have recruited the control group at the time of inclusion of patients and to have a 5-year follow-up also in the control group, since it is known that gastrointestinal symptoms in a Swedish population are varying over time [40]. However, in both the case of antibodies and symptoms, patients provide their own controls and the population-based material are merely intended to provide a benchmark control group, since IVF patients could represent a selected group. At inclusion, patients had more nausea and vomiting compared with controls. This may depend on that 60 of patients already had undergone IVF, and thus GnRH treatment, prior to this study, or to the many psychological factors associated with IVF [20]. Also, some of the 15 patients with past or concurrent endometriosis could have received GnRH analogs as treatment of their endometriosis, although GnRH analogs are not the first choice of treatment in this entity. To include patients for symptom registration, and not only blood samples, prior to the first treatment had been the most optimal.Conclusions We can conclude that although many patients experience gastrointestinal side effects during treatment with the GnRH analog buserelin, and an increase in abdominal pain and improved psychological well-being persists after five years, no severe dysmotility cases were prospectively observed amongst 62 patients in a 5-year perspective. Neither was there any detected development of antibodies against buserelin, GnRH, LH or their receptors related to buserelin treatment. The results are in line with prior large epidemiological studies stating that IVF treatment seems reasonably safe [41]. However, it remains to identify which patients who are at risk to develop serious, persistent gastrointestinal side effects after GnRH treatment [7,11]. Additional fileAdditional PubMed ID:https://www.ncbi.nlm.nih.gov/pubmed/28404814 file 1: Table S1. Concurrent diseases in patients subjected to in vitro fertilization. Abbreviations FSH: Follicle-stimulating hormone; GnRH: Gonadotropin-releasing hormone; hCG: Human chorionic gonadotropin; IVF: In vitro fertilization; LH: Luteinizing hormone; SF-36: 36-item Short-Form questionnaire; VAS-IBS: Visual Analogue Scale for Irritable Bowel Syndrome. Competing interests The authors declare that they have no competing interests. Authors’ contributions All authors together designed the study. OH and BO collected the data. BR developed and ran the ELISA tests. MB has developed the VAS-IBS. OH and BO performed the statistical calculations and wrote the manuscript. BO BasmisanilMedChemExpress RG1662 financially supported the study. All authors contributed to the manuscript with constructive criticism, and read and approved the final manuscript. Acknowledgem.