Faculty Opinions recommendation of Severe ovarian hyperstimulation syndrome after gonadotropin-releasing hormone (GnRH) agonist trigger and "freeze-all" approach in GnRH antagonist protocol.

2014 ◽  
Author(s):  
Raoul Orvieto
Keyword(s):  
Gnrh Agonist ◽  
Ovarian Hyperstimulation Syndrome ◽  
Gnrh Antagonist ◽  
Gonadotropin Releasing Hormone ◽  
Ovarian Hyperstimulation ◽  
Gnrh Agonist Trigger ◽  
Gnrh Antagonist Protocol ◽  
Severe Ovarian Hyperstimulation Syndrome ◽  
Agonist Trigger ◽  
Antagonist Protocol

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.

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).

GnRH antagonist rescue of a long-protocol IVF cycle and GnRH agonist trigger to avoid ovarian hyperstimulation syndrome: three case reports

2011 ◽  
Vol 95 (7) ◽  
pp. 2432.e17-2432.e19 ◽  
Author(s):  
Francisca Martínez ◽  
Dalia Beatriz Rodríguez ◽  
Rosario Buxaderas ◽  
Rosa Tur ◽  
Fulvia Mancini ◽  
...  
Keyword(s):  
Gnrh Agonist ◽  
Ovarian Hyperstimulation Syndrome ◽  
Gnrh Antagonist ◽  
Case Reports ◽  
Ovarian Hyperstimulation ◽  
Gnrh Agonist Trigger ◽  
Agonist Trigger ◽  
Long Protocol

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).

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