Luteal Coasting and Individualization of Human Chorionic Gonadotropin Dose after Gonadotropin-Releasing Hormone Agonist Triggering for Final Oocyte Maturation—A Retrospective Proof-of-Concept Study

Abstract

Ovarian stimulation in a gonadotropin-releasing hormone (GnRH) antagonist protocol with the use of GnRH agonist for final oocyte maturation is the state-of-the-art treatment in patients with an expected or known high response to avoid or at least reduce significantly the risk for development of ovarian hyperstimulation syndrome (OHSS). Due to a shortened LH surge after administration of GnRH agonist in most patients, the luteal phase will be characterized by luteolysis and luteal phase insufficiency. Maintaining a sufficient luteal phase is crucial for achievement of a pregnancy; however, the optimal approach is still under debate. Administration of human chorionic gonadotropin (hCG) within 72 h rescues the corpora lutea function; however, the so far often used 1,500 IU still bear the risk for development of OHSS. The recently introduced concept of “luteal coasting” individualizes the luteal phase support by monitoring the progesterone concentrations and administering a rescue dosage of hCG when progesterone concentrations drop significantly. This retrospective proof-of-concept study explored the correlation between hCG dosages ranging from 375 up to 1,500 IU and the progesterone levels in the early and mid-luteal phases as well as the likelihood of pregnancy, both early and ongoing. The chance of pregnancy is highest with progesterone level ≥13 ng/ml at 48 h postoocyte retrieval. Among the small sample size of 52 women studied, it appears that appropriate progesterone levels can be achieved with hCG dosages as low as 375 IU. This may well optimize the chance of pregnancy while reducing the risk of OHSS associated with higher doses of hCG supplementation in the luteal phase.

Live Birth Outcomes for PCOS Patients Under Depot Agonist Protocol or Antagonist Protocol - a retrospective Chinese cohort

“…The GnRH antagonist protocol can reduce OHSS because GnRH antagonist decreases VEGF mRNA expression [70]. The risk of OHSS is due to the effect of hCG [71], so using GnRHa to trigger ovulation and reducing hCG usage can reduce OHSS in the GnRH antagonist protocol [72,73]. There was no signi cant difference between the depot and daily GnRHa protocols in the rate of severe OHSS [20].…”

The effectiveness and safety of Chinese herbal medicine in infertile women with luteal phase deficiency: a systematic review and meta-analysis

“…Ovulation induction and progesterone supplements are often used in diagnosing and treating infertile women with luteal dysfunction (27). Common Western medical treatments include stimulation (28)(29)(30) and replacement therapies to recover luteal function (31)(32)(33). Progesterone is usually administered in the luteal phase to improve the luteal function of patients, but it cannot promote the development of follicles (34,35).…”

Creation of combined stabilizing compositions to preserve the activity of gonadotropins in liquid form

“…До гонадотропних гормонів належать фолікулостимулюючий (ФСГ), лютеїнізуючий (ЛГ) та тиреотропний гормони гіпофіза, а також гормон плаценти -хоріонічний гонадотропін (ХГ). Хоріонічний гонадотропін людини (ХГл) -плацентарний глікопротеїновий гормон, який діє через зв'язування з рецептором, зв'язаним з G-білком, що призводить до збільшення активності аденілатциклази [8].…”