Early luteal phase endocrine profile is affected by the mode of triggering final oocyte maturation and the luteal phase support used in recombinant follicle-stimulating hormone–gonadotropin-releasing hormone antagonist in vitro fertilization cycles

Fatemi, Human M.; Polyzos, Nikolaos P.; Vaerenbergh, Inge Van; Bourgain, Claire; Blockeel, Christophe; Alsbjerg, Birgit; Papanikolaou, Evangelos; Humaıdan, Peter

doi:10.1016/j.fertnstert.2013.05.028

Cited by 70 publications

(47 citation statements)

References 32 publications

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“…In contrast, progesterone concentrations return to baseline 5 days after GnRHa trigger, reflecting complete luteolysis by this day (Fatemi et al, 2013).…”

Section: Introductionmentioning

confidence: 88%

‘Luteal coasting’ after GnRH agonist trigger – individualized, HCG-based, progesterone-free luteal support in ‘high responders’: a case series

Kol

Breyzman

Segal

et al. 2015

Reproductive BioMedicine Online

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This study reports 21 IVF cases with excessive ovarian response, who received gonadotrophin-releasing hormone agonist (GnRHa) triggering for final oocyte maturation, followed by a human chorionic gonadotrophin (HCG)-based, progesterone-free, luteal support, individually timed ('luteal coasting') according to endogenous luteal progesterone concentrations. One patient developed a brief early-onset moderate ovarian hyperstimulation syndrome (OHSS) condition. Six clinical pregnancies were achieved, two of which have resulted in live births thus far. To further individualize the luteal phase support post GnRHa trigger, the same principle that holds for follicular coasting, used in the context of OHSS prevention, may be valid. Monitoring luteal progesterone concentrations from the day of oocyte retrieval, and administering a bolus of HCG (1500 IU) when the concentration drops significantly, seems to facilitate fresh embryo transfer, even in patients with excessive ovarian responses.

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“…In contrast, progesterone concentrations return to baseline 5 days after GnRHa trigger, reflecting complete luteolysis by this day (Fatemi et al, 2013).…”

Section: Introductionmentioning

confidence: 88%

‘Luteal coasting’ after GnRH agonist trigger – individualized, HCG-based, progesterone-free luteal support in ‘high responders’: a case series

Kol

Breyzman

Segal

et al. 2015

Reproductive BioMedicine Online

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“…From a clinical point of view, the most significant benefit of GnRHa trigger is its ability to induce a quick and reversible luteolysis and thus reduce the risk of OHSS development. Recently, it was demonstrated that gonadotropin and steroid levels differ significantly during the luteal phase between patients triggered for final oocyte maturation with a GnRHa or with hCG (Fatemi et al, 2013).…”

Section: Introductionmentioning

confidence: 99%

Strategies for the management of OHSS: Results from freezing-all cycles

Borges¹,

Braga²,

Setti³

et al. 2016

JBRA Assisted Reproduction

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Objective: To compare the use of GnRH agonist (GnRHa) or hCG trigger in potential OHSS patients undergoing freeze-all programs. We also compared the clinical outcomes when fresh versus freeze-thawed embryo transfers were performed in cycles with a high number of retrieved oocytes. Methods: The study included potential OHSS patients who received GnRHa (n=74) or hCG (n=49) trigger. The protocols were compared with respect to the clinical outcomes. We also compared the clinical outcomes of cycles in which hCG trigger was used and more than 20 MII oocytes were retrieved when: fresh embryo transfer protocol (n=153) or freeze-all protocol (n=123) were performed. Results: A decreased serum estradiol level, a decreased number of retrieved oocytes, an increased MII retrieved rate, and decreased fertilization rate was observed in the hCG when compared with the GnRHa group. No significant differences were noted concerning clinical outcomes. When fresh cycles were compared with frozen-thawed cycles, the estradiol serum level and the number of cryopreserved embryos were higher in the frozen-thawed cycles. The clinical pregnancy rate was higher among freeze-all cycles, as well as the implantation and cumulative pregnancy rates, when compared with fresh embryo transfer cycles. Conclusion:The use of GnRHa trigger may be a good alternative to prevent the OHSS in patients presenting an extreme ovarian response to COS, leading to similar clinical outcomes, when compared with the traditional hCG trigger. Moreover, our findings demonstrated that the strategy of freezing-all embryos not only decreases the risk of OHSS but also leads to a better pregnancy rate.

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“…Thus, supplementation with estradiol and progesterone may not be sufficient, as opposed to hCG with its LH-like activity. Indeed, studies demonstrated that the administration of 1,500 IU hCG 35 h after GnRHa triggering combined with micronized Progesterone resulted in a normalized luteal phase and a reproductive outcome similar to that of hCG triggering [11,14,26,[28][29][30][31][32].…”

Section: Discussionmentioning

confidence: 99%

Gonadotropin Releasing Hormone Agonist Final Oocyte Maturation and Human Chorionic Gonadotropin as Exclusive Luteal Support in Normal Responders

Beck-Fruchter

Baram

Geslevich

et al. 2018

Gynecol Obstet Invest

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Background/Aims: Gonadotropin releasing hormone (GnRH) agonist triggering results in an endogenous gonadotropin flare. Although it effectively stimulates ovulation, GnRH agonist triggers results in an early luteolysis and requires modification of the luteal support. The current study aims to evaluate GnRH agonist triggering with exclusive human chorionic gonadotropin (hCG) luteal support. Methods: In this prospective observational study, 56 normogonadotropic-assisted reproductive technology patients, stimulated using a GnRH-antagonist protocol, were studied. Final oocyte maturation was achieved with 0.2 mg triptorelin acetate followed by progesterone free luteal support with human choriogonadotropin (1,500 IU * 2). A control group was selected from a pool of 1,023 normogonadotropic patients who received Choriogonadotropin alfa for final oocyte maturation and progesterone suppositories for luteal support. Results: No significant difference was found for the number of oocytes, oocyte maturation rate, fertilization and implantation rate, clinical pregnancy rate (25 vs. 26.7%) and live birth rate (25 vs. 21.4%). Progesterone levels in conception cycles were significantly higher in the study group than corresponding levels in the control group. Conclusion: GnRH agonist triggering with exclusive hCG support may be a valid alternative to hCG triggering with progesterone support. This protocol combines the potential advantages of a physiological trigger with a simple, patient-friendly, luteal support.

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Early luteal phase endocrine profile is affected by the mode of triggering final oocyte maturation and the luteal phase support used in recombinant follicle-stimulating hormone–gonadotropin-releasing hormone antagonist in vitro fertilization cycles

Cited by 70 publications

References 32 publications

‘Luteal coasting’ after GnRH agonist trigger – individualized, HCG-based, progesterone-free luteal support in ‘high responders’: a case series

‘Luteal coasting’ after GnRH agonist trigger – individualized, HCG-based, progesterone-free luteal support in ‘high responders’: a case series

Strategies for the management of OHSS: Results from freezing-all cycles

Gonadotropin Releasing Hormone Agonist Final Oocyte Maturation and Human Chorionic Gonadotropin as Exclusive Luteal Support in Normal Responders

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