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

KnE Medicine ◽  
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

<p><strong>Introduction:</strong> 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.</p><p><strong>Objective:</strong> To compare IVF outcomes in patient using GnRH agonist trigger and hCG for final oocyte maturation.</p><p><strong>Method: </strong>A retrospective review of in vitro fertilization patient at Daya Medika Clinic and Yasmin Clinic.</p><p><strong>Result: </strong>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 group</p><p><strong>Conclusion: </strong>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</p>

scholarly journals A Flexible Multidose GnRH Antagonist versus a Microdose Flare-Up GnRH Agonist Combined with a Flexible Multidose GnRH Antagonist Protocol in Poor Responders to IVF

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Gayem İnayet Turgay Çelik ◽  
Havva Kömür Sütçü ◽  
Yaşam Kemal Akpak ◽  
Münire Erman Akar
Keyword(s):  
Gnrh Agonist ◽  
Gnrh Antagonist ◽  
Poor Responders ◽  
Vitro Fertilization ◽  
Significant Difference ◽  
Gnrh Antagonist Protocol ◽  
Group 2 ◽  
Antagonist Protocol ◽  
Group 1

Objective. To compare the effectiveness of a flexible multidose gonadotropin-releasing hormone (GnRH) antagonist against the effectiveness of a microdose flare-up GnRH agonist combined with a flexible multidose GnRH antagonist protocol in poor responders to in vitro fertilization (IVF).Study Design. A retrospective study in Akdeniz University, Faculty of Medicine, Department of Obstetrics and Gynecology, IVF Center, for 131 poor responders in the intracytoplasmic sperm injection-embryo transfer (ICSI-ET) program between January 2006 and November 2012. The groups were compared to the patients’ characteristics, controlled ovarian stimulation (COH) results, and laboratory results.Results. Combination protocol was applied to 46 patients (group 1), and a single protocol was applied to 85 patients (group 2). In group 1, the duration of the treatment was longer and the dose of FSH was higher. The cycle cancellation rate was significantly higher in group 2 (26.1% versus 38.8%). A significant difference was not observed with respect to the number and quality of oocytes and embryos or to the number of embryos transferred. There were no statistically significant differences in the hCG positivity (9.5% versus 9.4%) or the clinical pregnancy rates (7.1% versus 10.6%).Conclusion. The combination protocol does not provide additional efficacy.

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