HCG Trigger After Failed GnRH Agonist Trigger Resulted in Two Consecutive Live Births: A Case Report

Background: Failed gonadotropin-releasing hormone (GnRH) agonist trigger with no oocyte retrieved during aspiration of several follicles is a rare but recurrent situation that can be rescued by the termination of the aspiration procedure, retriggering by human chorion gonadotropin (hCG), and repeated oocyte pickup 36 h later. Failed GnRH agonist trigger is frustrating and unsatisfactory, and fertility doctors must be aware of possible hCG retriggering and retained opportunity for successful cycle outcome.Objective: In this case report, we present a woman who experienced failed GnRH agonist trigger and rescue hCG retrigger followed by two consecutive live births after frozen-thawed single blastocyst transfers.Methods: A case report.Results: Two healthy children were born in 2018 and 2020, respectively as a result of controlled ovarian stimulation for IVF, failed GnRH agonist trigger followed by hCG re-trigger, and successful retrieval of 25 oocytes.Conclusion: Retriggering with hCG after failed GnRH agonist trigger can result in consecutive live births, and such knowledge can prevent cycle cancellation and patient discouragement. Knowledge on retriggering with hCG and consecutive live births after failed GnRH agonist trigger can prevent cycle cancellation and patient discouragement.

P–220 Delayed-ICSI on day1-matured oocytes in low responders of different age groups

Study question Is the cycle outcome of day0-ICSI (day0-matured oocytes) and delayed-ICSI (day1-matured oocytes) in low responders affected by maternal age? Summary answer Delayed-ICSI improves cycle outcome of low responders in all age groups by providing additional blastocysts for embryo transfer and/or pre-implantation genetic testing for aneuploidies (PGT-A). What is known already We had previously compared the fertilization, blastulation, blastocyst utilisation, and euploidy rates between day0-ICSI and delayed-ICSI (Lee, C.S.S., 2018). We believed that patients who have <7 mature oocytes (low responders) can benefit by having their concomitant immature oocytes cultured to day 1. This study evaluates the benefit of delayed-ICSI in improving the cycle outcome of such low responders from different age groups. Study design, size, duration From January 2018 to December 2020, 434 IVF cycles in Alpha IVF & Women’s Specialists were classified as low responder (being <7 oocytes injected on day 0). The immature oocytes were further cultured and delayed-ICSI was done on day1-matured oocytes. Patients were divided into 3 groups: (A) ≤35 years old (n = 137; mean maternal age=32.5; range=23.0–35.0); (B) 36–40 years old (n = 208; mean maternal age=38.2; range=36.0–40.0); and (C) >40 years old (n = 89; mean maternal age=42.7; range=41.0–49.0). Participants/materials, setting, methods Semen samples were processed by density gradient centrifugation and/or swim-up method. Day0-matured oocytes were injected at 2.5–4.5 hours post-retrieval (PIEZO, Japan). Immature oocytes were further cultured for 18–24hours and delayed-ICSI was done immediately after maturity assessment. Injected oocytes were cultured up to 7 days and trophectoderm biopsy for PGT-A screening (IonTorrent, USA) was performed on selected blastocysts prior to vitrification (Cryotec, Japan). The cycle outcomes of day0-ICSI and delayed-ICSI were analysed and compared. Main results and the role of chance In Group A, the fertilisation, blastulation, blastocyst utilisation and euploidy rates of day0-ICSI and day1-ICSI were 80.0% vs. 70.9%, 74.7% vs. 33.6%, 57.1% vs. 17.9%, and 52.3% vs. 30.8% respectively. The fertilisation (p = 0.0024), blastulation (p = 0.0001), utilization (p = 0.001) and euploidy (p = 0.0205) rates of delayed-ICSI were significantly lower compared to day0-ICSI. In Group B, the fertilisation, blastulation, blastocyst utilisation and euploidy rates of day0-ICSI and day1-ICSI were 77.3% vs. 64.1%, 75.0% vs. 37.5%, 52.7% vs. 20.6% and 26.0% vs. 32.1% respectively. Delayed-ICSI showed significantly lower fertilisation (p = 0.0001), blastulation (p = 0.0001) and utilization (p = 0.0001) rates than day0-ICSI, but the euploidy rate was comparable (p = 03997). In Group C, the fertilisation, blastulation and blastocyst utilisation rates of day0-ICSI and delayed-ICSI were 76.6% vs. 56.4%, 67.1% vs. 22.8%, 34.3% vs. 7.9% respectively. Similar to Group B, the fertilization (p = 0.0001), blastulation (p = 0.0001) and utilisation (p = 0.0003) rates in day0-ICSI was significantly higher than delayed-ICSI. No significant difference was observed between the euploidy rates of day0-ICSI and delayed-ICSI (18.9% vs. 0.0%, p = 0.3452). Despite all blastocysts derived from delayed-ICSI in this group being aneuploid, it could still increase the chances of these patients obtaining an euploid blastocyst. Limitations, reasons for caution Analysis on Group B was done on a larger sample size compared to Group A and C. A larger sample size in Group A and C is needed to further support our results. Wider implications of the findings: Delayed-ICSI generates additional blastocysts for low responders from all age groups. Therefore, delayed-ICSI could be a routine procedure in low responder IVF patients in order to optimise the cycle and clinical outcomes. Trial registration number Not applicable

Comparison of Cycle Outcomes Among Women with Endometrioma or Non-Functional Cysts Versus Control

OBJECTIVE: This study aimed to compare cycle outcomes among women with endometrioma or non-functional cysts versus control. STUDY DESIGN: Women under 35 years of age with unexplained infertility underwent in vitro fertilization cycle. Two hundred and ninety-nine women were included in this study. Study groups consist of women with endometrioma (n=82) or non-functional ovarian cysts (n=100) and control group (n=117). Women in each group were selected consecutively. Groups were matched for age and ovarian reserve and compared in terms of in vitro fertilization cycle outcome. RESULTS: There were no significant differences among groups in terms of mean age, early follicular phase Follicle-Stimulating Hormone, and anti-müllerian hormone levels (p>0.05). Baseline total antral follicle counts were similar among groups (p>0.05). There were significant differences among groups in terms of mean starting and total gonadotropin dose, peak estradiol level, total oocyte number, and mature oocyte numbers (p<0.05). Clinical pregnancy rates were 10.7%, 17.3%, and 31.6% in groups with non-functional cyst, endometrioma and control group respectively (p<0.05). The presence of a non-functional cystic mass of ovary on the starting day of stimulation was a risk factor for poor cycle outcome in terms of clinical pregnancy rates [OR=0.5 (95 % CI; 0.2-0.9, p=0.03)]. CONCLUSION: Our data showed that the presence of any kind of cystic mass of the ovary especially the non-functional cysts on the starting day of stimulation was a risk factor for poor cycle outcomes in terms of clinical pregnancy rates.