Rescue of corpus luteum function with peri-ovulatory HCG supplementation in IVF/ICSI GnRH antagonist cycles in which ovulation was triggered with a GnRH agonist: a pilot study

Abstract

Previous studies found a poor clinical outcome when a GnRH agonist (GnRHa) was used to trigger ovulation in GnRH antagonist IVF/ICSI cycles. This study aimed to determine the clinical and endocrine effects as well the optimal timing of HCG supplementation. Forty-five normogonadotrophic IVF/ICSI patients following a flexible antagonist protocol were prospectively randomized (sealed envelopes) to triggering of ovulation with a single bolus of either 10,000 IU of HCG (group 1, n = 15) or 0.5 mg buserelin s.c. In addition, the GnRHa triggered group was randomized into two groups: group 2 (n = 17) was supplemented with HCG 1500 IU, 12 h after ovulation induction and group 3 (n = 13) was supplemented with HCG 1500 IU 35 h after ovulation induction. Group 1 and group 3 had significantly higher luteal phase concentrations of progesterone (P < 0.001) as compared with group 2. Moreover, the clinical pregnancy rate of groups 1 and 3 was similar and significantly higher (P < 0.02) than that of group 2. A larger study, however, is required to substantiate these differences. No differences were seen regarding mid-luteal inhibin A concentrations between the three groups. Triggering of ovulation with GnRHa supplemented with 1500 IU HCG 35 h later (group 3) seems to secure a normal luteal phase and a normal clinical pregnancy outcome.

Combined ovulation triggering with GnRH agonist and hCG in IVF patients

“…Despite the fact that triggering of ovulation with a GnRH agonist and 1500 IU hCG 35 h later in GnRH antagonist IVF cycles provides a normal luteal phase and pregnancy outcome comparing with a single bolus of 10,000 IU of hCG [22], concomitant administration of a GnRH agonist and the low hCG doses have been introduced as a socalled "dual trigger". The concept of a dual trigger has been investigated for IVF high responders who had significant risk factors for OHSS to aid in oocyte maturation and more sustained support for the corpus luteum.…”

Triggering final follicular maturation: hCG, GnRH-agonist, or both, when and to whom?

“…1) One bolus of 1500 IU hCG 35 h after the triggering bolus of GnRHa, i.e. one hour after oocyte retrieval [6,7], was demonstrated to rescue the luteal phase, resulting in a reproductive outcome comparable with that of HCG triggering, and with no increased risk of OHSS [8]. However, when applied to patients at high-risk to develop severe OHSS, 26 % developed severe early OHSS requiring ascites drainage and hospitalization [9].…”

Tekrarlayan Oosi̇t Matürasyon Aresti̇nde İki̇li̇ (Gnrh Agoni̇sti̇ Ve Hcg) Teti̇kleme Kullanilmasi / Dual Triggering (Gnrh Agonist and Hcg) in Repeated Total Oocyte Maturation Arrest

“…Bu sayede, M2 oosit sayısını ve yüzdesini arttırdığı düşünülmektedir (10,11,(16)(17)(18). Dolayısıyla, GnRH agonist uygulamasının hem FSH hem de LH salınımını daha fizyolojik olarak uyarması ve hCG eklenmiş sikluslarda biyolojik benzerlikleri dolayısıyla güçlenmiş LH pikini oluşturması, folikül matürasyonu üzerine olası etkilerine yönelik birçok hipotezin önünü açmaktadır (19).…”