Dual trigger with combination of gonadotropin-releasing hormone agonist and human chorionic gonadotropin significantly improves the live-birth rate for normal responders in GnRH-antagonist cycles

Lin, Ming-Huei; Wu, Frank; Lee, Robert Kuo-Kuang; Li, Sheng-Hsiang; Lin, Shing-Jong; Hwu, Yuh‐Ming

doi:10.1016/j.fertnstert.2013.07.1976

Cited by 133 publications

(134 citation statements)

References 50 publications

Supporting

Mentioning

106

Contrasting

Unclassified

Order By: Relevance

“…Lin et al [24], in their retrospective cohort study, have compared IVF outcome in normal responders patients undergoing COH using the GnRH antagonist with either a standard dosage of hCG trigger (6,500 IU of recombinant hCG) or the dual trigger (0.2 mg of triptorelin and 6,500 IU of recombinant hCG) 35-36 h prior to oocyte retrieval. The dual trigger group demonstrated statistically significantly higher number of oocytes retrieved, matured oocytes and number of embryos cryopreserved, with the consequent significant increase in implantation, clinical pregnancy and live-birth rates, as compared with the hCG-only trigger group.…”

Section: Ohss-almost Always Develops After Hcg Administration or In Ementioning

confidence: 99%

Triggering final follicular maturation: hCG, GnRH-agonist, or both, when and to whom?

Orvieto

2017

J Assist Reprod Genet

View full text Add to dashboard Cite

Controlled ovarian hyperstimulation (COH) which combines GnRH antagonist co-treatment and GnRH-agonist (GnRHa) trigger has become a common tool aiming to eliminate severe early OHSS and to support the concept of an OHSS-free clinic. However, due to the reported significantly reduced clinical, efforts have been made to improve reproductive outcome. One of the suggested optional strategies aiming to improve outcome was the addition of low-dose (1500 IU) HCG bolus, administered, concomitant, 35 h or 5 days after the triggering bolus of GnRHa. All these regimens were demonstrated to rescue the luteal phase, resulting in improved reproductive outcome in patients at risk to develop severe OHSS, compared to GnRHa trigger alone, however, with the questionable ability to eliminate severe OHSS. Moreover, following the observations demonstrating comparable or even better oocyte\embryos quality following GnRHa, compared to hCG trigger, and the different effects of LH and hCG on the downstream signaling of the LH receptor, GnRHa is now offered concomitant to the standard hCG trigger dose to improve oocyte/embryo yield and quality. GnRHa and hCG may be offered either concomitantly, 35-37 h prior to oocyte retrieval (dual trigger), or 40 h and 34 h prior to oocyte retrieval, respectively (double trigger).

show abstract

Section: Ohss-almost Always Develops After Hcg Administration or In Ementioning

confidence: 99%

Triggering final follicular maturation: hCG, GnRH-agonist, or both, when and to whom?

Orvieto

2017

J Assist Reprod Genet

View full text Add to dashboard Cite

show abstract

“…Bunun yanında over stimulasyonunun etkisiyle yüksek estradiol seviyelerine bağlı ilişki sonrası daha uzun süre spermlerin servikal mukusda canlı kalabileceği literatürde bildirilmiştir (16) GnRH agonistlerinin tetiklediği LH artışı muhtemelen korpus luteum fonksiyonlarının devamını sağlamak için yeterli olmamaktadır. Bu nedenle düşük doz hCG, ya GnRH agonistleri ile beraber ya da oosit toplama işlemi öncesi uygulanabilir (15,17). Primatlarda pituiter gonadotropin desteği olmadan eksojen uygulanan LH desteğinin 3 gün içerisinde sağlanması ile corpus luteumun devam edebildiği görülmüştür (18).…”

Section: Discussionunclassified

GNRH Agoni̇st İle Teti̇kleme Sonrasi Tüm Embri̇yolarin Dondurulduğu Olguda Spontan Kli̇ni̇k Gebeli̇k / Spontaneous Clinical Pregnancy Following GNRH Agonist Triggering and Freeze All Policy

Olgan

Dırıcan

Erturk

2016

Osmangazi̇ Journal of Medicine

View full text Add to dashboard Cite

ÖZET: Gonadotropin serbestleştirici hormon (GnRH) agonisti ile oosit matürasyonunun tetiklendiği ve sonrasında tüm embriyoların dondurulduğu 27 yaşındaki olguda luteal destek olmaksızın oluşan spontan klinik gebelik sunulmuştur. Polikistik over sendromu (PKOS) tanısıyla, öncesinde 3 sefer kontrollü ovaryan stimulasyon ve intrauterin inseminasyon uygulanmış olan hastaya GnRH antagonist protokolü ile intrasitoplasmik sperm enjeksiyonu tedavisi planlandı. Stimulasyonun 11. gününde ≥11 mm 25 adet folikül saptanması üzerine GnRH agonisti uygulanarak final oosit maturasyonu sağlandı. Blastokist evresine kadar gelişim gösteren yüksek kalitedeki embriyoların tümü vitrifiye edildi. Taze embriyo transferi planlanmaması dolayısıyla hastaya luteal faz desteği verilmeyerek yedi gün süreyle cinsel ilişki önerilmedi. Ancak, oosit toplanmasının 5 hafta sonrasında amenore yakınmasıyla tarafımıza tekrar başvuran hastaya yapılan transvajinal ultrasonografide fetal kalp atımı müspet spontan tekiz gebelik izlendi. Günümüzde, GnRH agonistlerle tetikleme sonrası luteal fazın nasıl desteklenmesi gerektiğine dair yoğun tartışmalar devam etmektedir. Bu bulgular, ovaryan stimulasyon sonrası suprafizyolojik steroid seviyelerine rağmen, her hastanın korpus luteum fonksiyonlarının devamının farklılık gösterebileceğine işaret etmektedir. Dolayısıyla, PKOS ve beraberinde endojen lüteinizan hormon aktivitesinin yüksek olduğu hastalar, korpus luteumun sınırlı ancak luteal faz için yeterli aktivitesinin devam edebileceği bir alt grubu oluşturuyor olabilir. ANAHTAR KELIMELER: GnRH agonist tetikleme, luteal faz desteği, spontan gebelik SPONTANEOUS CLINICAL PREGNANCY FOLLOWING GNRH AGONIST TRIGGERING AND FREEZE ALL POLICY ABSTRACT:We describe a 27 year-old patient undergoing follicle stimulation with gonadotrophin releasing hormone (GnRH) agonist and freeze-all approach, presented with spontaneous clinical pregnancy without supplementation of luteal phase. The patient had three attempts with controlled ovarian hyperstimulation and intrauterine insemination due to polycystic ovary syndrome (PCOS) before referring to our clinic for intracytoplasmic sperm injection. A GnRH antagonist protocol was assigned and ovarian stimulation commenced. After the detection of 25 follicles ≥11 mm, final oocyte maturation was triggered with GnRH agonist on the eleventh day of stimulation. Since freeze all approach was taken, no luteal phase support was administered. High quality blastocysts were vitrified. The couple was advised to refrain from sexual intercourse for seven days. The patient, however, presented with amenorrhea five weeks after the day of oocyte retrieval. A clinical pregnancy with fetal cardiac activity was determined on ultrasound examination. Currently, there is an ongoing debate on how best to counteract the negative impact of agonist triggering on the luteal phase. Our case demonstrates that corpus luteum functions might diverse despite supra-physiological sex steroids resulting from ovarian stimulation. Therefore, in case of PCOS consisting high e...

show abstract

“…Although the role of GnRH-a in triggering ovulation has been investigated in many trials before (5,8,10,(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32), most of these trials had heterogenous populations and mainly focused on patients receiving GnRH antagonist protocol prior to IVF/ ICSI and interventions with variable doses tested. Also, conflicting results have been obtained (Table 4).…”

Section: Discussionmentioning

confidence: 99%

“…Lin et al, have studied dual triggering with GnRH-a and hCG and found it to be superior to hCG triggering regarding implantation, pregnancy and live birth rates in IVF cycles induced with GnRH antagonist (29).…”

Section: Discussionmentioning

confidence: 99%

Triggering ovulation with gonadotropin-releasing hormone agonist versus human chorionic gonadotropin in polycystic ovarian syndrome. A randomized trial

Farag

El-deen

Hassan

2015

Middle East Fertility Society Journal

View full text Add to dashboard Cite

Objectives: To compare GnRH agonist to hCG for triggering ovulation in polycystic ovarian syndrome treated with clomiphene citrate. Study design: Prospective randomized study. Materials & methods: Eighty five infertile women with PCOS participated in a randomized allocation concealed prospective trial and had induction of ovulation with clomiphene citrate. GnRH agonist 0.2 mg subcutaneously (group 1) or hCG 10,000 IU intramuscularly (group 2) was given to trigger ovulation. Primary outcome was mid-luteal serum progesterone, while secondary outcomes were ovulation rates and clinical pregnancy rates along 3 cycles. Results: No difference was found between group 1 and group 2 regarding mean serum progesterone and clinical pregnancy rates in each cycle. Cumulative pregnancy rates were similar (17.14% versus 20% respectively; P = 0.332). Ovulation rates were 80% versus 68.6% (P = 0.413); 94.3% versus 90.9% (P = 0.669); 97.1% versus 93.7% (P = 0.603) in the two groups respectively. However, a significant rise in number of patients with mid-luteal serum progesterone >10 ng/mL was noted in the 3rd cycle between both groups, (P < 0.0001 for group 1 while P = 0.007 for group 2). Conclusion: Triggering ovulation with GnRH-a after treatment with clomiphene citrate in PCOS, in view of its known protective effect against OHSS, may be an effective physiological alternative

show abstract

Dual trigger with combination of gonadotropin-releasing hormone agonist and human chorionic gonadotropin significantly improves the live-birth rate for normal responders in GnRH-antagonist cycles

Cited by 133 publications

References 50 publications

Triggering final follicular maturation: hCG, GnRH-agonist, or both, when and to whom?

Triggering final follicular maturation: hCG, GnRH-agonist, or both, when and to whom?

GNRH Agoni̇st İle Teti̇kleme Sonrasi Tüm Embri̇yolarin Dondurulduğu Olguda Spontan Kli̇ni̇k Gebeli̇k / Spontaneous Clinical Pregnancy Following GNRH Agonist Triggering and Freeze All Policy

Triggering ovulation with gonadotropin-releasing hormone agonist versus human chorionic gonadotropin in polycystic ovarian syndrome. A randomized trial

Contact Info

Product

Resources

About