Failure of GnRH agonist-triggered oocyte maturation: its cause and management

Abstract

In cases where GnRHa fails to trigger oocyte maturation, a rescue protocol entailing re-triggering with HCG can produce successful outcomes.

Rescue hCG to treat empty follicle syndrome after the use of a GnRH agonist as oocyte maturation trigger: First report on fresh embryo transfer and clinical pregnancy

“…The incidence of EFS after the use of a GnRHa trigger in our population was 1.8% (6/322). This incidence varies based on the available studies (Griesinger et al, 2011;Honnma et al, 2011;Asada et al, 2013;Kummer et al, 2013) (Table III). Castillo et al (2012) reported the highest incidence (3.5%) based on a population of young, healthy oocyte donors.…”

“…When this is added to the data currently available (Asada et al, 2013;Kummer et al, 2013) in the literature, mature oocytes were collected with the use of rescue hCG in patients with EFS after a GnRH trigger in 92.3% of reported cases (12/13). All 6 patients responded during the phase of controlled ovarian stimulation with Ն 18 follicles Ͼ 11 mm.…”

“…With the expanding use of GnRH antagonist ovarian stimulation cycles, reports have emerged on the occurrence of EFS in patients who were administered a GnRHa as the oocyte maturation trigger (Griesinger et al, 2011;Honnma et al, 2011;Castillo et al, 2012;Asada et al, 2013;Kummer et al, 2013). Some of these reports (Griesinger et al, 2011;Honnma et al, 2011;2 G. Christopoulos et al Human Fertility Asada et al, 2013;Kummer et al, 2013) have highlighted the use of hCG as a potential rescue trigger in these cases.…”

“…Some of these reports (Griesinger et al, 2011;Honnma et al, 2011;2 G. Christopoulos et al Human Fertility Asada et al, 2013;Kummer et al, 2013) have highlighted the use of hCG as a potential rescue trigger in these cases. The current case series illustrates our experience with the use of hCG for the purposes of oocyte maturation following failure to collect any oocytes after the administration of a GnRHa.…”

Current Approaches to the Use of GnRH Agonist Trigger for Final Oocyte Maturation: Review

“…Bu öneriler; GnRHa trigger sonrası OPU günü tek overe OPU yapılması ve eğer oosit yoksa ya da çok az ise serum progesteron seviyesine bakılması, sonrasında ise serum progesteron seviyesi yüksek değilse hCG ile ikinci bir tetiklemeyi takiben ikinci OPU'nun bilateral overlere yapılması, son olarak da OPU'da toplanan bütün oositlerin daha sonra transfer edilmek üzere dondurulması şeklindedir. 40 …”