Substituting HCG with GnRH agonist to trigger final follicular maturation – a retrospective comparison of three different ovarian stimulation protocols

Abstract

The study retrospectively evaluated the influence of triggering final oocyte maturation with gonadotrophin-releasing hormone (GnRH) agonist on the outcome of IVF cycles. Four hundred and sixty consecutive women admitted to the IVF unit during a 4-year period were enrolled in the study. Ovarian stimulation characteristics and clinical pregnancy rate were compared between three groups: patients at risk of developing ovarian hyperstimulation syndrome (OHSS), undergoing either the long GnRH-agonist protocol (agonist group) or the flexible multidose GnRH-antagonist protocol who received GnRH-agonist for final oocyte maturation (antagonist-agonist group); and patients not at risk of developing severe OHSS undergoing the flexible multidose GnRH-antagonist protocol who received human chorionic gonadotrophin (HCG) for final oocyte maturation (antagonist-HCG group). Implantation and clinical pregnancy rates were lowest in the antagonist-agonist group despite the fact that no difference were was observed in fertilization rates between the groups. Moreover, the high-responder antagonist-agonist group required shorter stimulation and had higher numbers of oocytes retrieved as compared with the high-responder agonist-group. No case of severe OHSS was observed in the antagonist-agonist group. The use of flexible multidose GnRH-antagonist protocol with GnRH-agonist for final oocyte maturation, in high-responder patients, eliminates the risk of OHSS but results in decreased implantation and pregnancy rates.

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

“…Controlled ovarian hyperstimulation (COH) which combines GnRH antagonist co-treatment and GnRHa trigger has since become a common tool aiming to eliminate severe early OHSS and to support the concept of an OHSS-free clinic [2,3]. However, due to the reported significantly reduced clinical pregnancy and increased first trimester pregnancy loss [4,5], efforts have been made to improve reproductive outcome by manipulating the luteal phase. One of the suggested optional strategies aiming to improve outcome was the addition of low-dose (1500 IU) HCG bolus.…”

Ovulation triggering with GnRH agonist vs. hCG in the same egg donor population undergoing donor oocyte cycles with GnRH antagonist: a prospective randomized cross-over trial

“…A meta-analysis showed that the use of GnRH or hCG for final oocyte maturation, and in which GnRH antagonist was used to inhibit premature LH surge, yielded a comparable number of oocytes capable of undergoing fertilization and subsequent embryonic cleavage [4]. Moreover, a retrospective analysis of the use of GnRH agonist to trigger final oocyte maturation on the outcome of IVF cyclesfound that the use of a flexible multidose GnRH-antagonist protocol with GnRH-agonist for final oocyte maturation in fresh autologous cycles in highresponder patients eliminated the risk of OHSS [5]. However, the likelihood of an ongoing clinical pregnancy and implantation was significantly lower after GnRH agonist triggering compared with the standard hCG treatment [4,5].…”

“…Moreover, a retrospective analysis of the use of GnRH agonist to trigger final oocyte maturation on the outcome of IVF cyclesfound that the use of a flexible multidose GnRH-antagonist protocol with GnRH-agonist for final oocyte maturation in fresh autologous cycles in highresponder patients eliminated the risk of OHSS [5]. However, the likelihood of an ongoing clinical pregnancy and implantation was significantly lower after GnRH agonist triggering compared with the standard hCG treatment [4,5]. Agonist triggering has also been tested in frozen-embryo replacement IVF cycles; these studies found that the likelihood of a live birth after GnRH triggering of final oocyte maturation was not impaired, suggesting that the impaired clinical pregnancy and implantation rates in IVF cycles may be due to endometrial factors in antagonist cycles triggered for oocyte maturation with GnRH agonists [6].…”

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

“…27 Orvieto ve ark.nın OHSS için yüksek riskli 67 hastayı dâhil ederek yaptığı bir kohort çalışmada ise Engmann ve ark.nın çalışmasında belirtilen yoğun luteal destek uygulamalarına rağmen implantasyon ve klinik gebelik oranları, daha önce yaptıkları benzer ama yoğun luteal destek içermeyen çalışmanın sonuç-ları ile kıyaslanabilir seviyede düşük kalmıştır. 28,29 Griffin ve ark. 2012 yılında yeni bir yaklaşım olarak hastaları luteal destek için FOM tetikleme gü-nündeki östradiol konsantrasyonlarına göre ikiye ayırmayı önermişlerdir.…”