Improved clinical outcomes and lower OHSS risk with GnRH agonist trigger and hCG incorporated luteal support, compared to hCG trigger in GnRH-antagonist protocol for anticipated high responders

2013 ◽  
Vol 100 (3) ◽  
pp. S517
Author(s):  
A.K. Datta ◽  
A. Eapen ◽  
A. Kurinchi-Selvan ◽  
G. Lockwood
Keyword(s):  
Clinical Outcomes ◽  
Gnrh Agonist ◽  
Gnrh Antagonist ◽  
Luteal Support ◽  
Gnrh Agonist Trigger ◽  
Gnrh Antagonist Protocol ◽  
High Responders ◽  
Agonist Trigger ◽  
Antagonist Protocol ◽  
Hcg Trigger

Retrospective comparison of GnRH agonist trigger with HCG trigger in GnRH antagonist cycles in anticipated high-responders

2014 ◽  
Vol 29 (5) ◽  
pp. 552-558 ◽  
Author(s):  
Adrija Kumar Datta ◽  
Abey Eapen ◽  
Heidi Birch ◽  
Anitha Kurinchi-Selvan ◽  
Gillian Lockwood
Keyword(s):  
Gnrh Agonist ◽  
Gnrh Antagonist ◽  
Retrospective Comparison ◽  
Gnrh Agonist Trigger ◽  
High Responders ◽  
Agonist Trigger ◽  
Hcg Trigger

scholarly journals GnRH-Agonist Ovulation Trigger in Patients Undergoing Controlled Ovarian Hyperstimulation for IVF with Stop GnRH-Agonist Combined with Multidose GnRH-Antagonist Protocol

2021 ◽  
pp. 1-5
Author(s):  
Raoul Orvieto ◽  
Ravit Nahum ◽  
Judith Frei ◽  
Orit Zandman ◽  
Yulia Frenkel ◽  
...  
Keyword(s):  
Gnrh Agonist ◽  
Gnrh Antagonist ◽  
Outcome Measure ◽  
Main Outcome Measure ◽  
Final Oocyte Maturation ◽  
Gnrh Agonist Trigger ◽  
Gnrh Antagonist Protocol ◽  
Response Post ◽  
Agonist Trigger ◽  
Antagonist Protocol

<b><i>Objective:</i></b> This study aimed to characterize those patients undergoing the stop gonadotropin-releasing hormone (GnRH)-agonist combined with multidose GnRH-antagonist protocol, with suboptimal response to GnRH-agonist trigger in in vitro fertilization (IVF) cycles. <b><i>Design:</i></b> This is a cohort study. <b><i>Setting:</i></b> The study was conducted in a university hospital. <b><i>Patients:</i></b> All consecutive women admitted to our IVF unit from February 2020 through November 2020 who reached the ovum pick-up stage were reviewed. <b><i>Interventions:</i></b> Triggering final oocyte maturation by GnRH-ag alone (GnRH-ag trigger group), or combined with hCG (dual trigger group), in patients undergoing the stop GnRH-agonist combined with multidose GnRH-antagonist protocol was performed. <b><i>Main Outcome Measure:</i></b> The main outcome measure was LH level 12 h after the trigger. <b><i>Results:</i></b> Five out of the 32 patients (15.6%) demonstrated suboptimal response as reflected by LH levels &#x3c;15 IU/L 12 h after GnRH-agonist trigger. Moreover, while no differences were observed in oocyte recovery rate, maturity, or embryo quality between the different study groups (GnRH-ag trigger and dual trigger groups), those achieving a suboptimal response to the GnRH-agonist trigger (post-trigger LH &#x3c;15 mIU/mL) demonstrated significantly higher number of follicles and peak estradiol levels at the day of trigger, compared to those with optimal response (post-trigger LH &#x3e;15 mIU/mL). <b><i>Conclusions:</i></b> The stop GnRH-agonist combined with GnRH-antagonist protocol enables the substitution of hCG with GnRH-ag for final oocyte maturation. However, caution should be taken in high responders, where the dual trigger with small doses of hCG (1,000–1,500 IU) should be considered, aiming to avoid suboptimal response (post-trigger LH levels &#x3c;15 IU/L).

scholarly journals GnRH Agonist Ovulation Trigger in Patients Undergoing Controlled Ovarian Hyperstimulation for IVF with Stop GnRH-agonist Combined With Multidose GnRH-antagonist Protocol.

2021 ◽  
Author(s):  
Raoul Orvieto ◽  
Ravit Nahum ◽  
Judith Frei ◽  
Orit Zandman ◽  
Yulia Frenkel ◽  
...  
Keyword(s):  
Oocyte Maturation ◽  
Gnrh Agonist ◽  
Gnrh Antagonist ◽  
Study Groups ◽  
Serum Progesterone ◽  
Final Oocyte Maturation ◽  
Gnrh Agonist Trigger ◽  
Gnrh Antagonist Protocol ◽  
Agonist Trigger ◽  
Antagonist Protocol

Abstract Backround: Recently, the Stop GnRH agonist protocol has been used successfully in poor responder patients , those with poor embryos quality and those with elevated peak serum progesterone levels. The aim of the present study was to evaluate, whether GnRH-agonist trigger in patients undergoing the Stop protocol combined , will result in an optimal response/trigger, as reflected by post trigger LH >15 mIU/mL Methods: A retrospective cohort study. All consecutive women admitted to our IVF unit from February 2020 through November 2020 who reached the ovum pick-up stage. Patients triggered with GnRH-ag alone, or combined with hCG for final oocyte maturation were included in the study. LH levels were measured 12 hours post trigger.Results: Five out of the 32 patients (15.6%) demonstrated suboptimal response as reflected by LH levels <15 IU/L 12 hrs post GnRH-agonist trigger. Moreover, while no differences were observed in oocytes recovery rate, maturity or embryos quality between the different study groups, those achieving a suboptimal response to the GnRH-agonist trigger (post trigger LH <15 mIU/mL) demonstrated significantly higher number of follicles and peak estradiol levels at the day of trigger.Conclusions: The Stop GnRH-agonist combined with GnRH-antagonist protocol, enables the substitution of HCG with GnRH-ag for final oocyte maturation. However, caution should be taken in high responders, where the dual trigger with small doses of hCG (1000-1500IU) should be considered, aiming to avoid suboptimal response (post trigger LH levels <15IU/L).

scholarly journals Luteal Support with very Low Daily Dose of Human Chorionic Gonadotropin after Fresh Embryo Transfer as an Alternative to Cycle Segmentation for High Responders Patients Undergoing Gonadotropin-Releasing Hormone Agonist-Triggered IVF

2021 ◽  
Vol 14 (3) ◽  
pp. 228
Author(s):  
Andrea Roberto Carosso ◽  
Stefano Canosa ◽  
Gianluca Gennarelli ◽  
Marta Sestero ◽  
Bernadette Evangelisti ◽  
...  
Keyword(s):  
Embryo Transfer ◽  
Chorionic Gonadotropin ◽  
Gnrh Agonist ◽  
Human Chorionic Gonadotropin ◽  
Luteal Phase ◽  
Real Life ◽  
Luteal Support ◽  
Gnrh Agonist Trigger ◽  
High Responders ◽  
Agonist Trigger

The segmentation of the in vitro fertilization (IVF) cycle, consisting of the freezing of all embryos and the postponement of embryo transfer (ET), has become popular in recent years, with the main purpose of preventing ovarian hyperstimulation syndrome (OHSS) in patients with high response to controlled ovarian stimulation (COS). Indeed cycle segmentation (CS), especially when coupled to a GnRH-agonist trigger, was shown to reduce the incidence of OHSS in high-risk patients. However, CS increases the economic costs and the work amount for IVF laboratories. An alternative strategy is to perform a fresh ET in association with intensive luteal phase pharmacological support, able to overcome the negative effects of the GnRH-agonist trigger on the luteal phase and on endometrial receptivity. In order to compare these two strategies, we performed a retrospective, real-life cohort study including 240 non-polycystic ovarian syndrome (PCO) women with expected high responsiveness to COS (AMH >2.5 ng/mL), who received either fresh ET plus 100 IU daily human chorionic gonadotropin (hCG) as luteal support (FRESH group, n = 133), or cycle segmentation with freezing of all embryos and postponed ET (CS group, n = 107). The primary outcomes were: implantation rate (IR), live birth rate (LBR) after the first ET, and incidence of OHSS. Overall, significantly higher IR and LBR were observed in the CS group than in the FRESH group (42.9% vs. 27.8%, p < 0.05 and 32.7% vs. 19.5%, p < 0.05, respectively); the superiority of CS strategy was particularly evident when 16–19 oocytes were retrieved (LBR 42.2% vs. 9.5%, p = 0.01). Mild OHSS appeared with the same incidence in the two groups, whereas moderate and severe OHSS forms were observed only in the FRESH group (1.5% and 0.8%, respectively). In conclusion, in non-PCO women, high responders submitted to COS with the GnRH-antagonist protocol and GnRH-agonist trigger, CS strategy was associated with higher IR and LBR than the strategy including fresh ET followed by luteal phase support with a low daily hCG dose. CS appears to be advisable, especially when >15 oocytes are retrieved.

scholarly journals Comparison of hCG Versus Gonadotropin-Releasing Hormone Agonist to Induce Oocyte Maturation in Assisted Reproductive Technology Cycles: A Retrospective Study

2020 ◽  
pp. 1
Author(s):  
Gulay Beydilli Nacak ◽  
Elif Tozkır ◽  
Enis Ozkaya ◽  
Ebru Cogendez ◽  
Fatih Kaya
Keyword(s):  
Gnrh Agonist ◽  
Polycystic Ovarian Syndrome ◽  
Gnrh Antagonist ◽  
Control Group ◽  
Study Group ◽  
Ovarian Morphology ◽  
Gnrh Agonist Trigger ◽  
Ovarian Syndrome ◽  
Agonist Trigger ◽  
Hcg Trigger

<p><strong>OBJECTIVE:</strong> To compare some cycle characteristics and outcomes using a protocol consisting of a GnRH agonist trigger or hCG trigger after cotreatment with GnRH antagonist.</p><p><strong>STUDY DESIGN:</strong> Thirty-three patients under 35 years of age with polycystic ovarian syndrome, polycystic ovarian morphology, or previous high response who underwent ovulation trigger by GnRH agonist trigger and 132 patients under 35 years of age with the polycystic ovarian syndrome, polycystic ovarian morphology, or previous high response who underwent ovulation trigger by hCG for IVF treatment. Patients were non-randomly assigned to an ovarian stimulation protocol consisting of either GnRH agonist trigger after cotreatment with GnRH antagonist (study group) or hCG trigger after antagonist protocol (control group).</p><p><strong>RESULTS:</strong> The positive pregnancy test was obtained in 70 women in the control group whereas in 13 cases in the study group (p=0.161). No case in the study group needed hospitalization whereas there were 15 cases in the control group who were required to be hospitalized due to ovarian hyperstimulation related symptoms (p=0.04).</p><p><strong>CONCLUSIONS:</strong> The use of a protocol consisting of a GnRH agonist trigger after GnRH antagonist cotreatment and freeze-all strategy reduces the risk of ovarian hyperstimulation syndrome in high-risk patients undergoing IVF without affecting pregnancy rates.</p>

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