GnRH agonist with low-dose hCG (dual trigger) is associated with higher risk of severe ovarian hyperstimulation syndrome compared to GnRH agonist alone

O’Neill, Kathleen; Senapati, Suneeta; Maina, Ivy W.; Gracia, Clarisa R.; Dokras, Anuja

doi:10.1007/s10815-016-0755-8

Cited by 44 publications

(53 citation statements)

References 64 publications

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“…The “birds-eye” view of these data along with the basic research demonstrating the reasonable mechanisms of action suggest that more standardized, prospective trials that are better powered, randomized, and ideally blinded, would be prudent. Any future studies would do well to consider the 24 to 36 hour half-life of the HCG used in a trigger shot, as LH activity (mimicked by HCG in the trigger) has been shown to be the major driver in OHSS symptomatology [ 32 33 ]. With this in mind, administration of the GnRH antagonist prior to post-trigger day 3 would likely have a blunted benefit, and therefore researchers may prefer to focus on therapy initiation around post trigger day 5 for maximum effect as shown in some of the above studies.…”

Section: Discussionmentioning

confidence: 99%

The use of gonadotropin-releasing hormone antagonist post-ovulation trigger in ovarian hyperstimulation syndrome

Chappell

Gibbons

2017

Clin Exp Reprod Med

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The purpose of this paper is to assimilate all data pertaining to the use of gonadotropin-releasing hormone (GnRH) antagonists in in vitro fertilization cycles after ovulation trigger to reduce the symptoms of ovarian hyperstimulation syndrome (OHSS). A systematic review of the literature was performed to identify all studies performed on the use of a GnRH antagonist in IVF cycle post-ovulation trigger with patients at high risk for OHSS. Ten studies were identified and reviewed. Descriptions of the studies and their individual results are presented in the following manuscript. Due to significant heterogeneity among the studies, it was not possible to perform a group analysis. The use of GnRH antagonists post-ovulation trigger for treatment of OHSS has been considered for almost 20 years, though research into its use is sparse. Definitive conclusions and recommendations cannot be made at this time, though preliminary data from these trials demonstrate the potential for GnRH antagonists to play a role in the treatment of OHSS in certain patient populations.

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Section: Discussionmentioning

confidence: 99%

The use of gonadotropin-releasing hormone antagonist post-ovulation trigger in ovarian hyperstimulation syndrome

Chappell

Gibbons

2017

Clin Exp Reprod Med

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“…However, we must be careful, for it is not possible to assess whether Dual Trigger increases the risk of OHSS when compared to the GnRH agonist alone (Engmann et al ., 2008). Moreover, O'Neill et al (2016) showed that the risk of OHSS has been increasing in high responder patients treated under the Dual Trigger strategy.…”

Section: Discussionmentioning

confidence: 99%

Final Oocyte Maturation in Assisted Reproduction with Human Chorionic Gonadotropin and Gonadotropin-releasing Hormone agonist (Dual Trigger)

Oliveira¹,

Calsavara²,

Cortés³

2016

JBRA Assisted Reproduction

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Final oocyte maturation with Human Chorionic Gonadotropin (hCG) and ovarian stimulation with Follicle Stimulation Hormone (FSH) combined with Gonadotrophin-releasing Hormone (GnRH) antagonist to block Luteinizing hormone (LH) surge is a standard procedure of in vitro Fertilization (IVF) and Intracytoplasmic Sperm Injection (ICSI). However, GnRH agonist has been replacing the use of hCG in certain situations, especially in patients at risk of Ovarian Hyperstimulation Syndrome (OHSS). Some studies have also shown advantages in the combined use of GnRH agonist concurrently with hCG in inducing final oocyte maturation, a treatment known as "Dual Trigger". In theory, this method combines the advantages of both induction regimens, and it has brought promising results. The objective of this study is to compare Dual Trigger with the use of hCG alone or the use of GnRH agonist alone. A systematic review of articles on Dual Trigger and a retrospective cohort study comparing the three methods of induction of final oocyte maturation have been conducted. It has been found that Dual Triggering for poor responder patients had a statistically significant increase in the number of retrieved oocytes, mature oocytes, and fertilized embryos in the positive beta hCG rate, implantation rate, and newborn/transferred embryo (TE) rate.

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“…Stimulation parameters including stimulation protocol, starting gonadotropin dose, highest gonadotropin dose, total duration of stimulation, number of follicles at trigger, estradiol on day of trigger (pg/mL), type of trigger (HCG vs. Lupron only vs. HCG + Lupron [24]), oocyte yield (mature and immature), development of moderate or severe OHSS (as defined by ASRM [25]), and cycle cancelation data were collected.…”

Section: Methodsmentioning

confidence: 99%

Medical and elective fertility preservation: impact of removal of the experimental label from oocyte cryopreservation

Schon

Shapiro

Gracia

et al. 2017

J Assist Reprod Genet

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Although the populations presenting for medical compared with elective fertility preservation differ at baseline, ovarian stimulation parameters and outcomes are similar when adjusted for age. Insurance benefits for fertility preservation are not comprehensive and impact the decision to proceed with stimulation in all patients. The publication of the ASRM guidelines on oocyte cryopreservation increased utilization of this technology among patients presenting electively; however, they remained at an advanced age and with decreased ovarian reserve parameters.

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GnRH agonist with low-dose hCG (dual trigger) is associated with higher risk of severe ovarian hyperstimulation syndrome compared to GnRH agonist alone

Abstract: Dual trigger for final oocyte maturation using GnRHa and low-dose hCG is associated with a significantly increased risk of severe OHSS compared to GnRH alone. However, dual trigger may be associated with a modest increase in oocyte yield, both in terms of number and maturity.

Cited by 44 publications

References 64 publications

The use of gonadotropin-releasing hormone antagonist post-ovulation trigger in ovarian hyperstimulation syndrome

The use of gonadotropin-releasing hormone antagonist post-ovulation trigger in ovarian hyperstimulation syndrome

Final Oocyte Maturation in Assisted Reproduction with Human Chorionic Gonadotropin and Gonadotropin-releasing Hormone agonist (Dual Trigger)

Medical and elective fertility preservation: impact of removal of the experimental label from oocyte cryopreservation

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