The use of gonadotropin-releasing hormone (GnRH) agonist to induce oocyte maturation after cotreatment with GnRH antagonist in high-risk patients undergoing in vitro fertilization prevents the risk of ovarian hyperstimulation syndrome: a prospective randomized controlled study

Purpose To analyze the cycle outcomes and the incidence of ovarian hyperstimulation syndrome (OHSS), when oocyte maturation was triggered by gonadotropin-releasing hormone agonist (GnRHa) versus human chorionic gonadotropin (hCG) in breast cancer patients undergoing fertility preservation. Methods One hundred twenty-nine women aged≤45 years, diagnosed with stage≤3 breast cancer, with normal ovarian reserve who desired fertility preservation were included in the retrospective cohort study. Ovarian stimulation was achieved utilizing letrozole and gonadotropins. Oocyte maturation was triggered with GnRHa or hCG. Baseline AMH levels, number of oocytes, maturation and fertilization rates, number of embryos, and the incidence of OHSS was recorded. Results The serum AMH levels were similar between GnRHa and hCG groups (2.7±1.9 vs. 2.1±1.8; p=0.327). There was one case of mild or moderate OHSS in the GnRHa group compared to 12 in the hCG group (2.1 % vs. 14.4 %, p=0.032). The maturation and fertilization rates, and the number of cryopreserved embryos were significantly higher in the GnRHa group.Conclusions GnRHa trigger improved cycle outcomes as evidenced by the number of mature oocytes and cryopreserved embryos, while significantly reducing the risk of OHSS in breast cancer patients undergoing fertility preservation.

Section: Discussionmentioning

confidence: 93%

Triggering final oocyte maturation with gonadotropin-releasing hormone agonist (GnRHa) versus human chorionic gonadotropin (hCG) in breast cancer patients undergoing fertility preservation: an extended experience

Reddy

Turan

Bedoschi

et al. 2014

“…However, the likelihood of an ongoing clinical pregnancy was significantly lower after GnRH agonist triggering than after standard HCG treatment [4]. Other studies have also indicated that the use of a protocol consisting of GnRH agonist triggering after GnRH antagonist cotreatment, combined with adequate luteal phase and early pregnancy E 2 and progesterone supplementation, reduces the risk of OHSS in high-risk patients undergoing IVF without affecting the implantation rate [12,13]. The probable endometrial effect of the GnRH agonist used in antagonist cycles was eliminated by comparative studies in egg donor models.…”

Section: Dıscussıonmentioning

confidence: 99%

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

Şişmanoğlu¹,

Tekin²,

Erden³

et al. 2009

Objective To compare fertilization, implantation and pregnancy rates in donor oocyte cycles triggered for final oocyte maturation with either human chorionic gonadotropin (hCG) or gonadotropin releasing hormone (GnRH) agonist in the same donor population in two sequential stimulation cycles. Design Prospective randomized cross-over trial. Setting Private infertility clinic. Patient(s) Eighty-eight stimulation cycles in 44 egg donors. Interventions Controlled ovarian hyperstimulation (COH) with GnRH antagonist protocol triggered with hCG or GnRH agonist (leuprolide acetate 0.15 mg) in the same egg donors in two consecutive cycles. Main outcome measure(s) The primary outcome measure was the proportion of mature and fertilized oocytes per donor cycle. Secondary outcome measures were implantation and pregnancy rates in the recipients and incidence of ovarian hyperstimulation syndrome (OHSS) in oocyte donors. Result(s)The proportion of mature oocytes, fertilized oocytes and mean embryo scores were comparable between the two triggering agents. While implantation (36.53% vs, 32.93%), pregnancy (69.08% vs. 68.81%) and clinical pregnancy (41.3% vs. 40.2%) rates were comparable for the groups, the incidence of OHSS was significantly lower in GnRH than in hCG triggered cycles. Conclusion(s) Fertilization, implantation and pregnancy rates from donor oocytes stimulated with GnRH antagonist protocol were identical for donor cycles triggered with hCG and GnRH agonist. GnRH antagonist triggering in egg donors was associated with lower rates of OHSS.

“…While its general incidence is approximately 2 to 3 % per cycle [2,1], OHSS can occur in up to a third of all cases of high-risk patients [3,4], notably those with a previous history of OHSS or polycystic ovary morphology (PCOM)/polycystic ovary syndrome (PCOS). In its severe form, this syndrome has the potential to cause serious morbidity or mortality, mainly due to the increased occurrence of ovarian torsion and thromboembolism [5].…”

Section: Introductionmentioning

confidence: 99%

Ovarian hyperstimulation syndrome after gonadotropin-releasing hormone agonist triggering and “freeze-all”: in-depth analysis of genetic predisposition

Santos‐Ribeiro

Polyzos

Stouffs

et al. 2015

Purpose We report on the results of the whole-genome analysis performed in a patient who developed severe ovarian hyperstimulation syndrome (OHSS) following gonadotropinreleasing hormone (GnRH) agonist triggering in a Bfreeze-allp rotocol.Methods A 30-year-old patient with polycystic ovary syndrome who developed severe early-onset OHSS with clinical ascites, and slight renal and hepatic dysfunction was admitted for monitoring and treatment with cabergoline and intravenous albumin. Exome sequencing to assess for any known genetic predisposition for OHSS was performed.Results No known genetic variants associated with OHSS predisposition were found. Conclusions Case reports of severe OHSS following a Bfreeze-all^strategy are starting to arise, showing that OHSS has not been completely eliminated with this approach. Further studies should be conducted to confirm if such cases may be due to genetic predisposition or not.