Spontaneous clinical pregnancy following GNRH agonist trigger for final oocyte maturation and freeze-all approach: a case report

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).

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Maternal and neonatal outcomes after GnRH-AGONIST trigger for final oocyte maturation in patients undergoing in vitro fertilization (IVF)

Fertility and Sterility ◽

10.1016/j.fertnstert.2012.07.953 ◽

2012 ◽

Vol 98 (3) ◽

pp. S261-S262

Author(s):

T.H. Budinetz ◽

D.W. Griffin ◽

J. Pinto ◽

C.A. Benadvia ◽

J.C. Nulsen ◽

...

Keyword(s):

In Vitro Fertilization ◽

Oocyte Maturation ◽

Gnrh Agonist ◽

Neonatal Outcomes ◽

Vitro Fertilization ◽

Final Oocyte Maturation ◽

Gnrh Agonist Trigger ◽

Maternal And Neonatal Outcomes ◽

Agonist Trigger

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

Turkiye Klinikleri Journal of Gynecology and Obstetrics ◽

10.5336/gynobstet.2015-48941 ◽

2017 ◽

Vol 27 (2) ◽

pp. 94-100

Author(s):

Ali SEVEN ◽

Hikmet HASSA

Keyword(s):

Oocyte Maturation ◽

Gnrh Agonist ◽

Final Oocyte Maturation ◽

Gnrh Agonist Trigger ◽

Agonist Trigger

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Outcomes Comparison of In-Vitro Fertilization (IVF) between GnRH Agonist Trigger and hCG for Final Oocyte Maturation

KnE Medicine ◽

10.18502/kme.v1i1.529 ◽

2016 ◽

Vol 1 (1) ◽

Author(s):

Ade Permana

Keyword(s):

In Vitro Fertilization ◽

Oocyte Maturation ◽

Gnrh Agonist ◽

Gnrh Agonists ◽

Vitro Fertilization ◽

Final Oocyte Maturation ◽

Gnrh Agonist Trigger ◽

Agonist Trigger ◽

Antagonist Protocol

Introduction: For decades, human chorionic gonadotropin (hCG) has been used for final oocyte maturation. It is proven to have highest life birth rate, comparing to gonadotropin releasing hormone (GnRH) agonist, but unfortunately it can increases the risk of developing ovarian hyper stimulation syndrome (OHSS). There is an ongoing debate over the optimal agent that can trigger final oocyte maturation in antagonist protocol, leading to higher IVF success rate without increasing the risk of OHSS.Objective: To compare IVF outcomes in patient using GnRH agonist trigger and hCG for final oocyte maturation.Method: A retrospective review of in vitro fertilization patient at Daya Medika Clinic and Yasmin Clinic.Result: 76 women were analyzed consist of 38 women using GnRH agonist and 38 women using hCG. We found no significant differences on biochemical pregnancy rate (24.00% and 20.51%) between two group, but there were significant differences on fertilization rate (67.72% and 61.32%), cleavage rate (95.04% and 88.92%) and blastocyst rate (13.90% and 7.38%). There was one patient developed OHSS in hCG groupConclusion: GnRH agonists can be considered for use as a trigger final oocyte maturation in the antagonist protocol because some IVF outcomes data showed that GnRH agonists triggering were better than hCG without increasing the risk of OHSS

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Pregnancy outcomes with frozen-thawed single euploid blastocyst transfer following IVF cycles using HCG versus GNRH agonist trigger for final oocyte maturation

Fertility and Sterility ◽

10.1016/j.fertnstert.2019.02.079 ◽

2019 ◽

Vol 111 (4) ◽

pp. e29-e30

Author(s):

Reeva Makhijani ◽

Jeffrey Thorne ◽

Chantal Bartels ◽

John Nulsen ◽

Daniel Grow ◽

...

Keyword(s):

Oocyte Maturation ◽

Gnrh Agonist ◽

Pregnancy Outcomes ◽

Blastocyst Transfer ◽

Final Oocyte Maturation ◽

Gnrh Agonist Trigger ◽

Agonist Trigger

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GnRH agonist and hCG (dual trigger) versus hCG trigger for final follicular maturation: a double-blinded, randomized controlled study

Human Reproduction ◽

10.1093/humrep/deaa107 ◽

2020 ◽

Vol 35 (7) ◽

pp. 1648-1654 ◽

Cited By ~ 2

Author(s):

J Haas ◽

R Bassil ◽

N Samara ◽

E Zilberberg ◽

C Mehta ◽

...

Keyword(s):

Oocyte Maturation ◽

Gnrh Agonist ◽

Interim Analysis ◽

Birth Rate ◽

Live Birth Rate ◽

Clinical Pregnancy ◽

Follicular Maturation ◽

Final Oocyte Maturation ◽

Randomized Controlled ◽

Double Blinded

Abstract STUDY QUESTION Does co-administration of GnRH agonist and Human chorionic gonadotropin (hCG; dual trigger) in IVF cycles improve the number of mature oocytes and pregnancy outcome compared to hCG alone? SUMMARY ANSWER Using the dual trigger for final follicular maturation increases the number of oocytes, mature oocytes and number of blastocysts (total and top-quality) compared to triggering with hCG alone. WHAT IS KNOWN ALREADY hCG is used at the end of controlled ovarian hyperstimulation as a surrogate LH surge to induce final oocyte maturation. Recently, based on retrospective studies, the co-administration of GnRH agonist and hCG for final oocyte maturation (dual trigger) has been suggested to improve IVF outcome and pregnancy rates STUDY DESIGN, SIZE, DURATION A single center, randomized controlled, double-blinded clinical trial between May 2016 and June 2018 analyzed by intention to treat (ITT). PARTICIPANTS/MATERIALS, SETTINGS, METHODS One hundred and fifty-five normal responder patients were randomized either to receive hCG or dual trigger for final oocyte maturation. Data on patients age, BMI, AMH, number of oocytes retrieved, number of metaphase 2 (MII) oocytes, zygotes and blastocysts, clinical pregnancy rate and live birth rate were assessed and compared between the dual trigger group and the hCG group. We performed a planned interim analysis after the recruitment of 50% of the patients. Based on the totality of outcomes at the interim analysis we decided to discontinue further recruitment. MAIN RESULTS AND THE ROLE OF CHANCE One hundred and fifty-five patients were included in the study. The age (36 years versus 35.3 years P = NS), BMI (24 kg/m2 versus 23.7 kg/m2) and the AMH (20.1 pmol/l versus 22.4 pmol/l) were comparable between the two groups. Based on ITT analysis, the number of eggs retrieved (11.1 versus 13.4, P = 0.002), the MII oocytes (8.6 versus 10.3, P = 0.009), total number of blastocysts (2.9 versus 3.9, P = 0.01) and top-quality blastocysts transferred (44.7% versus 64.9%; P = 0.003) were significantly higher in the dual trigger group compared to the hCG group. The clinical pregnancy rate (24.3% versus 46.1%, OR 2.65 (1.43–1.93), P = 0.009) and the live birth rate per transfer (22% versus 36.2%, OR= 1.98 (1.05–3.75), P = 0.03) were significantly higher in the dual trigger group compared to the hCG group. LIMITATIONS, REASONS FOR CAUTION None. WIDER IMPLICATIONS OF THE FINDINGS The enhanced response observed with the dual trigger might lead to better IVF outcomes were it used more widely. STUDY FUNDING/COMPETING INTEREST(S) The study was funded by TRIO Fertility. There are no conflicts of interest to declare. TRIAL REGISTRATION NUMBER ClinicalTrials.gov identifier: NCT02703584 DATE OF TRIAL REGISTRATION March 2016 DATE OF FIRST PATIENT'S ENROLLMENT May 2016

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Empty follicle syndrome after GnRH agonist trigger, rescued with HCG in a donor oocyte with successful pregnancy outcome: a case report

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20160410 ◽

2016 ◽

pp. 549-551

Author(s):

Akshaya Mahapatro ◽

Kundavi Shankar ◽

Thankam Varma

Keyword(s):

Case Report ◽

Pregnancy Outcome ◽

Gnrh Agonist ◽

Successful Pregnancy ◽

Donor Oocyte ◽

Empty Follicle Syndrome ◽

Gnrh Agonist Trigger ◽

Agonist Trigger

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

Gynecologic and Obstetric Investigation ◽

10.1159/000517177 ◽

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

Objective: 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. Design: This is a cohort study. Setting: The study was conducted in a university hospital. Patients: All consecutive women admitted to our IVF unit from February 2020 through November 2020 who reached the ovum pick-up stage were reviewed. Interventions: 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. Main Outcome Measure: The main outcome measure was LH level 12 h after the trigger. Results: Five out of the 32 patients (15.6%) demonstrated suboptimal response as reflected by LH levels <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 <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 >15 mIU/mL). 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 (1,000–1,500 IU) should be considered, aiming to avoid suboptimal response (post-trigger LH levels <15 IU/L).

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