Clinical Pregnancy and Incidence of Ovarian Hyperstimulation Syndrome in High Ovarian Responders Receiving Different Doses of hCG Supplementation in a GnRH-Agonist Trigger Protocol

Objective. Ovarian hyperstimulation syndrome (OHSS) is a side effect of the exogenous human chorionic gonadotropin (hCG) hormones used to trigger oocyte maturation. High ovarian responders represent a population with a higher risk of OHSS and are characterized by an exaggerated response to gonadotropin administration. In this study, we compared clinical pregnancy and incidence of OHSS in high ovarian responders receiving different doses of hCG supplementation in a GnRH-agonist trigger protocol. Methods. A total of 205 high ovarian responders who were to undergo in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) cycles were recruited and randomly assigned to receive different doses of hCG supplementation in a GnRH-agonist trigger protocol: GnRH-a (n = 42), GnRH-a + 1000 IU hCG (n = 49), GnRH-a + 2000 IU hCG (n = 54), and GnRH-a + 3000 IU hCG (n = 60) groups. Results. The GnRH-a + 1000 IU hCG, GnRH-a + 2000 IU hCG, and GnRH-a + 3000 IU hCG groups had more oocytes retrieved, embryos, high-quality embryos, and a higher rate of high-quality embryos than the GnRH-a group ( p < 0.05 ). The GnRH-a + 1000 IU hCG group demonstrated more oocytes retrieved, embryos, high-quality embryos, and a higher rate of high-quality embryos than the GnRH-a + 2000 IU hCG and GnRH-a + 3000 IU hCG groups ( p < 0.05 ). No moderate and severe OHSS cases occurred in the GnRH-a and GnRH-a + 1000 IU hCG groups. The incidence rate of moderate and severe OHSS was remarkably lower in the GnRH-a group and GnRH-a + 1000 IU hCG groups than in the GnRH-a + 2000 IU hCG and GnRH-a + 3000 IU hCG groups ( p < 0.05 ). The GnRH-a + 1000 IU hCG, GnRH-a + 2000 IU hCG, and GnRH-a + 3000 IU hCG groups had a higher clinical pregnancy rate than the GnRH-a group, showing no significant difference ( p > 0.05 ). The GnRH-a + 1000 IU hCG, GnRH-a + 2000 IU hCG, and GnRH-a + 3000 IU hCG groups had a lower abortion rate than the GnRH-a group ( p < 0.05 ). Conclusion. Based on the data obtained from this prospective study, we recommend 1000 IU hCG supplementation in a GnRH-agonist trigger protocol for high ovarian responders during IVF/ICSI cycles considering a higher rate of high-quality embryos, a lower incidence rate of moderate and severe OHSS, and a lower abortion rate.

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

Obstetrics Gynecology and Reproductive Sciences ◽

10.31579/2578-8965/070 ◽

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.

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Ovarian hyperstimulation syndrome following GnRH agonist trigger—think ectopic

Journal of Assisted Reproduction and Genetics ◽

10.1007/s10815-017-0960-0 ◽

2017 ◽

Vol 34 (9) ◽

pp. 1161-1165 ◽

Cited By ~ 5

Author(s):

Raoul Orvieto ◽

Valeria Stella Vanni

Keyword(s):

Gnrh Agonist ◽

Ovarian Hyperstimulation Syndrome ◽

Ovarian Hyperstimulation ◽

Gnrh Agonist Trigger ◽

Agonist Trigger

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

International Journal of Infertility & Fetal Medicine ◽

10.5005/jp-journals-10016-1131 ◽

2016 ◽

Vol 7 (2) ◽

pp. 68-72 ◽

Cited By ~ 1

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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