Gonadotropin-releasing hormone agonist combined with a reduced dose of human chorionic gonadotropin for final oocyte maturation in fresh autologous cycles of in vitro fertilization (original) (raw)
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Fertility and sterility, 2016
To compare outcomes of in vitro fertilization (IVF) cycles with adequate versus inadequate response to the GnRH agonist trigger rescued with the use of hCG retrigger, and to identify risk factors associated with an inadequate trigger. Retrospective cohort study. Private practice. Women at high risk for ovarian hyperstimulation syndrome who underwent an autologous IVF cycle and used GnRH agonist to trigger oocyte maturation before oocyte retrieval. Patients were triggered with GnRH agonist for final oocyte maturation before retrieval. Patients with an inadequate response, defined by low post-trigger serum LH and P concentrations or failure to recover oocytes after aspiration of several follicles, were retriggered with hCG. Number of oocytes retrieved, fertilization rate, clinical pregnancy, and live birth. Two percent of patients triggered with GnRH agonist had an inadequate response and were retriggered with hCG. There was no statistically significant difference in clinical outcomes...
Fertility and Sterility, 2008
Objective: To determine whether there are any differences in the incidence of ovarian hyperstimulation syndrome (OHSS) and implantation rates in high-risk patients undergoing IVF using a protocol consisting of GnRH agonist trigger after cotreatment with GnRH antagonist or hCG trigger after dual pituitary suppression protocol. Design: Prospective randomized controlled trial. Setting: University-based tertiary fertility center. Patient(s): Sixty-six patients under 40 years of age with polycystic ovarian syndrome, polycystic ovarian morphology, or previous high response undergoing IVF. Intervention(s): Patients were randomized to an ovarian stimulation protocol consisting of either GnRH agonist trigger after cotreatment with GnRH antagonist (study group) or hCG trigger after dual pituitary suppression with a GnRH agonist (control group). Both groups received luteal phase and early pregnancy supplementation with IM progesterone (P), and patients in the study group also received E 2 patches and their doses were adjusted according to the serum levels. Main Outcome Measure(s): Incidence of OHSS and implantation rate. Result(s): None of the patients in the study group developed any form of OHSS compared with 31% (10/32) of the patients in the control group. There were no significant differences in the implantation 61 [36.0%] vs. 20/64 [31.0%]), clinical pregnancy (17/30 [56.7%] vs. 15/29 [51.7%]), and ongoing pregnancy rates (16/30 [53.3%] vs. 14/29 [48.3%]) between the study and control groups, respectively. Conclusion(s): The use of a protocol consisting of GnRH agonist trigger after GnRH antagonist cotreatment combined with adequate luteal phase and early pregnancy E 2 and P supplementation reduces the risk of OHSS in high-risk patients undergoing IVF without affecting implantation rate. (Fertil Steril Ò 2008;89:84-91. Ó2008
Pharmacological Options to Trigger Final Oocyte Maturation in In Vitro Fertilization
Journal of South Asian Federation of Obstetrics and Gynaecology
Human chorionic gonadotropin (hCG) has been the gold standard in the induction of final oocyte maturation since the pioneer days of in vitro fertilization (IVF). But owing to its long half-life, it leads to increased risk of ovarian hyperstimulation syndrome (OHSS). Trigger of GnRH agonist is a more physiological trigger, effective, and safe, as it significantly reduces or eliminates risk of OHSS. Newer options of dual trigger and double trigger are discussed in this review, which can be used as modified luteal phase support in patients with expected suboptimal oocyte maturation. Newer pharmaceutical options such as Kissepeptins, key in central regulation of neuroendocrine system, and GnRH release need more studies before being implemented in general practice. This review includes details of various trigger options for final oocyte maturation and about combination of trigger options aiming safe and effective outcomes.
Fertility and Sterility, 2005
To determine whether the serum concentration of hCG on the day after hCG administration (abbreviated throughout this article as [hCG]) is related to the incidence of ovarian hyperstimulation syndrome (OHSS), oocyte recovery per follicle, fertilization, blastulation, embryo transfer, implantation, and clinical pregnancy. Design: Retrospective study. Setting: Private infertility clinic. Patient(s): The OHSS study group included 849 non-donor IVF cycles performed between with patients younger than 35 years of age. Intervention(s): None. Main Outcome Measure(s): Occurrence of OHSS, severity of OHSS, [hCG], proportion of follicles yielding oocytes, fertilization rate, blastulation rate, transfer rate, implantation rate, and clinical pregnancy rate. Result(s): No significant relationships were observed between [hCG] and the proportion of follicles yielding oocytes, fertilization rate, blastulation rate, or the probabilities of embryo transfer, implantation, or clinical pregnancy. The incidence of OHSS (all types) and OHSS requiring transvaginal paracentesis were predicted by [hCG] (Pϭ.02 and Pϭ.05, respectively) and with follicle count (PϽ.0001 in both cases). Conclusion(s): These results suggest that moderated hCG dosage is useful in preventing OHSS without reducing efficacy. (Fertil Steril 2005;84:93-8.
Fertility and Sterility, 2010
Gonadotropin-releasing hormone agonist to induce final oocyte maturation prevents the development of ovarian hyperstimulation syndrome in high-risk patients and leads to improved clinical outcomes compared with coasting Ninety-four women undergoing IVF with peak E 2 level >4000 pg/mL received leuprolide acetate (LA) trigger (LA trigger group) or had gonadotropins withheld for one or more days (coasting group) followed by hCG trigger, unless cycle cancellation occurred. There were no cases of ovarian hyperstimulation syndrome in either group, and the LA trigger group had significantly more oocytes retrieved (26.9 AE 9.5 vs. 17.7 AE 9.3) P<0.001, more normally fertilized oocytes (15.0 AE 7.8 vs. 10.3 AE 6.3) P=0.01, and higher clinical and ongoing pregnancy rates than the coasting group (52.5% vs. 27.2%; 49.2% vs. 24.2%, P=0.02 for both comparisons, respectively).
Fertility and Sterility, 2007
In this retrospective study of 74 oocyte-donor IVF cycles, the rates of fertilization, implantation, clinical pregnancy, ongoing pregnancy, and early pregnancy loss were similar after an agonist or hCG trigger. These findings suggest that the agonist trigger is a viable alternative for oocyte donors with significant risk factors for ovarian hyperstimulation syndrome. (Fertil Steril 2007;88:237-9. Oocyte donors are preferentially selected for their high oocyte yields, and therefore tend to have many risk factors for ovarian hyperstimulation syndrome (OHSS). These include young age, high concentration of serum E 2 , and a large number of follicles (1, 2).
Fertility and Sterility, 2011
Objective: To determine factors predicting cycle success after in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) in high-risk patients undergoing controlled ovarian stimulation with a gonadotropinreleasing hormone (GnRH) antagonist protocol with a GnRH agonist to induce oocyte maturation. Design: Retrospective cohort study. Setting: University-based tertiary fertility center. Patient(s): Women who underwent a GnRH antagonist protocol during IVF-ICSI cycles and received a GnRH agonist for oocyte maturation. Intervention(s): GnRH-agonist trigger. Main Outcome Measure(s): Clinical and ongoing pregnancy rates and any occurrence of ovarian hyperstimulation syndrome (OHSS).
International Journal of Reproductive BioMedicine, 2017
Background: The purpose of triggering in ovulation induction is to induce the final maturation of oocytes and their release from the ovary for fertilization. Objective: The aim of the present study was to compare the effectiveness of gonadotropin-releasing hormone (GnRH) agonist and human chorionic gonadotropin (HCG) on the final maturation of oocytes and pregnancy rates in intrauterine insemination (IUI) cycles. Materials and Methods: In this randomized clinical trial, 110 infertile women who were selected for IUI entered the study. Ovulation induction was performed. Group I received 0.1 mg GnRH agonist as triggering and group II received 10,000 IU of HCG. The serum Estradiol (E 2), Luteinizing Hormone (LH), and Follicle-Stimulating Hormone (FSH) levels were measured at 12 and 36 hr after injection. Results: LH surge was detected in all patients. LH levels at 12 and 36 hr after triggering was higher in Group I and it washed out earlier than group II (p=0.00). The pregnancy rate was higher in Group I, but the difference was not statistically significant (26.9% vs. 20.8%, respectively p=0.46). Also, the incidence of ovarian hyperstimulation syndrome was not different between the two groups (p=0.11). There was a significant difference regarding the estradiol levels at 36 hours after triggering (p=0.00). Conclusion: Effects of GnRH on endogenous LH surge is sufficient for oocyte releasing and final follicular maturation. Pregnancy rates and ovarian hyperstimulation syndrome incidence were not different between the groups. We suggest that GnRH agonists might be used as an alternative option instead of HCG in IUI cycles.
Fertility and Sterility, 2006
Objective: Evaluate the effectiveness of a new ovarian stimulation (OS) protocol before IVF. Design: Prospective clinical randomized trial. Setting: Private centers. Patient(s): Three hundred and twenty-three intended-to-treat women candidates for IVF. Intervention(s): Patients were divided into three groups and administered the following treatments: group A, recombinant hFSH from day 3 until follicles reached 13-14mm, when recombinant hFSH was lowered to 75 IU daily and daily injections of 200 IU of hCG and a GnRH antagonist were administered until final maturation; group B, recombinant hFSH and a GnRH antagonist; group C, recombinant hFSH and a GnRH agonist. Main Outcome Measure(s): Primary outcome was the number of mature oocytes. Secondary outcomes included average initial and total recombinant hFSH dosage, serum E 2 level on day of ovulation, number of oocytes retrieved, fertilization, number of top-quality embryos, endometrial thickness, implantation rate, pregnancy rate (PR), and incidence of ovarian hyperstimulation syndrome (OHSS).