HCG Trigger of GnRH Agonist-Induced Functional Ovarian Cysts Does Not Decrease Clinical Pregnancy Rate in GnRHa Pretreated Frozen Cycles: Evidence From a Retrospective Cohort Study

Abstract

BackgroundGnRH agonist (GnRHa) pretreatment before the frozen-thawed embryo transfer (FET) was increasingly utilized. However, the incidence of GnRHa-induced functional ovarian cysts (FC) was inevitable. The feasibility and efficacy of HCG triggering GnRHa-induced FC are unknown.ObjectiveThe aim of the study was to investigate the effect of HCG triggering GnRHa-induced FC on FET outcomes.MethodsA total of 657 HRT-FET cycles with GnRHa pretreatment were retrospectively analyzed. Patients were divided into the FC group and the no functional cysts (NC) group according to whether the patient developed FC (follicular diameter of ≥7 mm and E2 of ≥100 pg/ml). Risk factors associated with the incidence of GnRHa-induced FC were determined by multivariate regression analysis. Pregnancy outcomes were compared between the FC group and the NC group. Propensity score matching (PSM) was performed to reduce the impact of confounding factors. Three multivariate regression models were performed to assess the association between HCG triggering GnRHa-induced FC and clinical pregnancy. Interactive analysis and subgroup analysis were also analyzed.ResultsThe incidence rate of GnRHa-induced FC was 9.74%. Older age (aOR 1.10, 95% CI 1.05-1.15, p-value < 0.001) and lower BMI (aOR 0.81, 95% CI 0.71-0.93, p-value=0.002) are risk factors for GnRHa-induced FC. The implantation rate, clinical pregnancy rate (CPR), and miscarriage rate were not significantly different between the FC group and the NC group before or after PSM (p-value > 0.05). Multivariate logistic models showed that HCG triggering GnRHa-induced FC does not decrease CPR in the general population (p-value > 0.05). The effect of HCG triggering GnRHa-induced FC on clinical pregnancy is interactive with age (p-value for interaction: 0.003); HCG trigger is associated with significantly higher CPR than HRT-FET cycles without FC in patients ≥35 years (aOR 4.40, 95% CI 1.57–12.3, p-value = 0.005).ConclusionsHCG triggering GnRHa-induced FC does not decrease the chance of clinical pregnancy in HRT-FET cycles pretreated with GnRHa.

Management of Simple Ovarian Cysts

“…The incidence of GnRHa-induced functional cysts is 9.3% to 9.74%. 36,37 There are conflicting data regarding the impact of ovarian cysts on IVF cycle outcomes. Although some studies have reported decreased number and quality of retrieved oocytes and embryos, and decreased implantation and pregnancy rates among those with GnRHa-induced ovarian cysts, 36,38,39 other studies have demonstrated no difference in IVF outcomes.…”

“…One of the known side effects of gonadotropin-releasing hormone agonists (GnRHa), commonly used in vitro fertilization (IVF) treatment, is the development of functional ovarian cysts. The incidence of GnRHa-induced functional cysts is 9.3% to 9.74% 36,37. There are conflicting data regarding the impact of ovarian cysts on IVF cycle outcomes.…”