Suboptimal response to GnRH agonist trigger

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Peter Humaidan ◽  
Shahar Kol
Keyword(s):  
Gnrh Agonist ◽  
Gnrh Agonist Trigger ◽  
Agonist Trigger

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.

P–667 Dydrogesterone supplementation in cycles triggered with lone GnRH agonist for final oocyte maturation resulted in an acceptable pregnancy rate

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
M Safrai ◽  
S Hertsberg ◽  
A Be Meir ◽  
B Reubinoff ◽  
T Imbar ◽  
...  
Keyword(s):  
Pregnancy Rate ◽  
Embryo Transfer ◽  
Gnrh Agonist ◽  
Luteal Phase ◽  
Fresh Embryo Transfer ◽  
Luteal Support ◽  
Luteal Phase Support ◽  
Gnrh Agonist Trigger ◽  
The Mean ◽  
Agonist Trigger

Abstract Study question Can luteal oral Dydrogesterone (Duphaston) supplementation in an antagonist cycle after a lone GnRH agonist trigger rescue the luteal phase, allowing the possibility to peruse with fresh embryo transfer? Summary answer Functionality of the luteal phase in an antagonist cycle after a lone GnRH agonist trigger can be restored by adding Duphaston to conventional luteal support. What is known already Ovarian hyperstimulation syndrome (OHSS) is dramatically reduced when using antagonist cycle with lone GnRH agonist trigger before ovum pick up. This trigger induces short luteinizing hormone (LH) and follicle-stimulating hormone (FSH) peaks, associated with reduced progesterone and estrogen levels during the luteal phase. They cause an inadequate luteal phase and a significantly reduced implantation rate leading to a freeze all practice in those cycles. Study design, size, duration A retrospective cohort study. The study group (n = 123) included women that underwent in vitro fertilization cycles from January 2017 to May 2020. Patients received a GnRH-antagonist with a lone GnRH-agonist trigger due to imminent OSHH. The control group (n = 374) included patients under 35 years old that, during the same time period, underwent a standard antagonist protocol with a dual trigger of a GnRH-agonist and hCG. Participants/materials, setting, methods Study patients were given Dydrogesterone (Duphaston) in addition to micronized progesterone vaginal pills (Utrogestan) for luteal support (Duphaston group). Controls were treated conventionally with Utrogestan for luteal phase support (hCG group). The outcomes measured were pregnancy rate and OHSS events. Main results and the role of chance Our study was the first to evaluate the addition of Duphaston to standard luteal phase support in an antagonist cycle triggered by a lone GnRH agonist before a fresh embryo transfer. The mean number of oocytes retrieved and estradiol plasma levels were significantly higher in the Duphaston group than in the hCG group (16.9 ±7.7 vs. 10.8 ± 5.3 and 11658 ± 5280 pmol/L vs. 6048 ± 3059 pmol/L, respectively). The fertilization rate was comparable between the two groups. The mean number of embryos transferred and the clinical pregnancy rate were also comparable between groups (1.5 ± 0.6 vs 1.5 ± 0.5 and 46.3% vs 40.9%, respectively). No OHSS event was reported in either group. Limitations, reasons for caution This retrospective study may carry an inherent selection and information bias, derived from medical record coding. An additional limitation was the choice of physician for the lone GnRH trigger, which may have introduced a selection bias and another potential caveat was the relatively small sample size of our study groups. Wider implications of the findings: The addition of Duphaston to conventional luteal support could effectively salvage the luteal phase without increasing the risk for OHSS. This enables, to peruse in those cycle, with fresh embryo transfer, avoiding the need to freeze all the embryos and postponed embryo transfer. Leading to lower psychological burden and costs. Trial registration number 0632–20-HMO

Severe ovarian hyperstimulation syndrome with GnRH agonist trigger during the COVID pandemic: lessons learned from an unusual case

2021 ◽  
Vol 5 (04) ◽  
pp. 01-04
Author(s):  
Bradley S Hurst ◽  
Evan Schrader ◽  
Tanner Hurley ◽  
Lariena Welch ◽  
Ying Ying ◽  
...  
Keyword(s):  
Gnrh Agonist ◽  
Ovarian Hyperstimulation Syndrome ◽  
Unusual Case ◽  
Oocyte Retrieval ◽  
Lessons Learned ◽  
Ovarian Hyperstimulation ◽  
Gnrh Agonist Trigger ◽  
Severe Ovarian Hyperstimulation Syndrome ◽  
Agonist Trigger ◽  
Severe Ohss

Background: Injectable gonadotropins stimulate multi-follicular recruitment and allows retrieval of multiple oocytes for assisted reproduction. The widespread utilization of gonadotropin releasing hormone agonist (GnRHa) to induce oocyte maturation for oocyte retrieval has nearly eliminated the risk of severe ovarian hyperstimulation syndrome (OHSS), and only a few cases have been reported in the literature. The rarity of severe OHSS may lead to the mistaken conclusion that gonadotropin stimulation can be safely administered with limited monitoring, even in high-risk patients. We present an unusual case of a woman with limited monitoring due to the COVID pandemic who developed severe OHSS before GnRH agonist trigger and oocyte. Case Presentation: A 29-year-old nulliparous woman with polycystic ovarian syndrome (PCOS) initiated ovarian stimulation for oocyte retrieval. She had a robust initial response, and developed worsening abdominal pain, bloating, nausea, vomiting, and decreased appetite before retrieval. GnRH agonist was given to “trigger ovulation and retrieval scheduled due to the low reported incidence of severe OHSS. Symptoms progressed, and on the morning of retrieval, ultrasound demonstrated bilaterally enlarged ovaries >10cm and 48 oocytes were retrieved for a planned cryo-all cycle. She was hospitalized on the day of retrieval for severe OHSS and had two large-volume paracenteses. She was stable and discharged home by day 5, and symptoms markedly improved with the onset of menses. She has an ongoing pregnancy from her first frozen embryo transfer. Conclusion: We add a rare case of severe OHSS with a GnRHa trigger and cryo-all protocol with the onset of symptoms before GnRH agonist administration. Although rare, severe OHSS may still occur with a GnRHa trigger, and caution is needed when an initial robust response is identified. Here we also provide an opportunity to review the important patient risk factors for the development of OHSS and measures to reduce the risk in excessive responders.

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 trigger in ‘freeze-all’ cycles: improves pregnancy rates and patient safety

2019 ◽  
Vol 112 (3) ◽  
pp. e206
Author(s):  
Marcus J. Davenport ◽  
Martin Healey ◽  
Vivien B. MacLachlan ◽  
Alon J. Talmor ◽  
Beverley J. Vollenhoven
Keyword(s):  
Patient Safety ◽  
Gnrh Agonist ◽  
Pregnancy Rates ◽  
Gnrh Agonist Trigger ◽  
Agonist Trigger

GnRH ANTAGONIST-INDUCED HYPOTHALAMIC SUPPRESSION AS A PREDICTOR OF SUBOPTIMAL RESPONSE TO GnRH AGONIST TRIGGER

2020 ◽  
Vol 114 (3) ◽  
pp. e290
Author(s):  
Christine Yang ◽  
Phillip A. Romanski ◽  
Pietro Bortoletto ◽  
David Reichman ◽  
Zev Rosenwaks
Keyword(s):  
Gnrh Agonist ◽  
Gnrh Antagonist ◽  
Gnrh Agonist Trigger ◽  
Agonist Trigger

Severe Early-onset Ovarian Hyperstimulation Syndrome following Use of GnRH Agonist Trigger along with Low-dose hCG

2016 ◽  
Vol 7 (2) ◽  
pp. 68-72 ◽  
Author(s):  
K Muthukumar ◽  
TK Aleyamma ◽  
Sumi Thomas
Keyword(s):  
Gnrh Agonist ◽  
Early Onset ◽  
Luteal Phase ◽  
Ovarian Hyperstimulation Syndrome ◽  
Low Dose ◽  
Ovarian Hyperstimulation ◽  
Gnrh Agonist Trigger ◽  
Risk Patients ◽  
Low Dose Hcg ◽  
Agonist Trigger

ABSTRACT Controlled ovarian hyperstimulation, which is a key component of assisted reproductive technology (ART) treatment, can be excessive in certain cases and can lead to massive cystic enlargement of the ovaries and biochemical changes, leading to ovarian hyperstimulation syndrome (OHSS). Traditionally, human chorionic gonadotropin (hCG) has been used as ovulation trigger in ART cycles but its sustained luteotrophic effect is associated with an increased risk of OHSS in high-risk patients. Gonadotropin-releasing hormone (GnRH) agonist trigger can be used as an alternative to hCG in GnRH antagonist downregulated cycles. However, the use of GnRH agonist was associated with a lower pregnancy rate due to deficient luteal phase, and hence, use of low-dose hCG to rescue the deficient luteal phase has been used. Various studies showed that using lowdose hCG did not increase the risk of OHSS even in high-risk patients. Here, we present a case report of severe early-onset OHSS following GnRH agonist trigger with low-dose hCG. How to cite this article Thomas S, Kamath MS, Muthukumar K, Aleyamma TK. Severe Early-onset Ovarian Hyperstimulation Syndrome following Use of GnRH Agonist Trigger along with Low-dose hCG. Int J Infertil Fetal Med 2016;7(2):68-72.

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