Use of a single bolus of GnRH agonist triptorelin to trigger ovulation after GnRH antagonist ganirelix treatment in women undergoing ovarian stimulation for assisted reproduction, with special reference to the prevention of ovarian hyperstimulation syndrome: preliminary report: Short communication

Abstract

A new treatment option for patients undergoing ovarian stimulation is the gonadotrophin-releasing hormone (GnRH) antagonist protocol, with the possibility to trigger a mid-cycle LH surge using a single bolus of GnRH agonist, reducing the risk of developing ovarian hyperstimulation syndrome (OHSS) in high responders and the chance of cycle cancellation. This report describes the use of 0.2 mg triptorelin (Decapeptyl) to trigger ovulation in eight patients who underwent controlled ovarian hyperstimulation with recombinant FSH (rFSH, Puregon) and concomitant treatment with the GnRH antagonist ganirelix (Orgalutran) for the prevention of premature LH surges. All patients were considered to have an increased risk for developing OHSS (at least 20 follicles > or =11 mm and/or serum oestradiol at least 3000 pg/ml). On the day of triggering the LH surge, the mean number of follicles > or =11 mm was 25.1 +/- 4.5 and the median serum oestradiol concentration was 3675 (range 2980-7670) pg/ml. After GnRH agonist injection, endogenous serum LH and FSH surges were observed with median peak values of 219 and 19 IU/l respectively, measured 4 h after injection. The mean number of oocytes obtained was 23.4 +/- 15.4, of which 83% were mature (metaphase II). None of the patients developed any signs or symptoms of OHSS. So far, four clinical pregnancies have been achieved from the embryos obtained during these cycles, including the first birth following this approach. It is concluded that GnRH agonist effectively triggers an endogenous LH surge for final oocyte maturation after ganirelix treatment in stimulated cycles. Our preliminary results suggest that this regimen may prove effective in triggering ovulation and could be said to prevent OHSS in high responders. The efficacy and safety of such new treatment regimen needs to be established in comparative randomized studies.

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

“…Although hCG is widely used for final oocyte maturation, its prolonged luteotrophic effect leads to supraphysiological levels of estradiol and progesterone, leading, in many cases, to the development of hyperstimulation syndrome [2]. The most common and severe complication of ovarian hyperstimulation is OHSS.…”

“…A new treatment option for egg donors undergoing ovarian stimulation is the gonadotropin-releasing hormone (GnRH) antagonist protocol, in which a single bolus of GnRH agonist can trigger a mid-cycle LH surge. This protocol is efficient in triggering ovulation and may prevent OHSS in high responders [2]. High responders showed acceptable rates of fertilization, implantation, clinical pregnancy, ongoing pregnancy and early pregnancy loss after triggering final maturation with GnRH agonist and hCG [3].…”

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

“…In 2000, Itskovitz-Eldor et al [1] described the first series of patients, at risk to develop severe OHSS, that underwent COH using the GnRH-antagonist with GnRH-agonist (GnRHa) trigger for final follicular maturation. While 50 % conceived, none of the patients developed any signs or symptoms of OHSS.…”

Evaluation and comparison of the antifertility potential activity and adverse effects of Trigonella foenum-graecum seeds and combined oral contraceptive pills in female rats

“…In the first group; negative control group (the normal not pregnant rats), the FSH concentration was in the normal range 182.86 ng/ml, which is high compared to the positive control group (the normal pregnant rats), in the not pregnant rats, the FSH secretions will be normal because the rats still ovulating due to FSH release which trigger the ovulation. 13 But in the pregnant rats, the FSH was significantly low 84.86 ng/ml because the rats were pregnant, means there is no ovulation, the results were in the agreement that FSH level will decrease when the mammals are pregnant because of no ovulation. 14 In the third group; COCPs treated group, the FSH concentration was significantly low 71.56 ng/ml and this observation was in the agreement that the FSH level will decrease when the females will be treated with contraceptive medications as the mechanism and pharmacodynamics of the contraceptive medications were related to decrease the level of FSH in the body, eventually stopping the ovulation and thereby no pregnancy will occur, this was proved and with agereement with many studies that amenorrhea which is absence of menstrual cycle associated with low FSH values and chronic anovulation.…”