GnRH Agonist Triggers and their Use in Assisted Reproductive Technology: The Past, the Present and the Future

Atkinson, Paul; Koch, Juliette; Susic, Daniella; Ledger, William

doi:10.2217/whe.14.14

Cited by 10 publications

(5 citation statements)

References 39 publications

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“…Given that the vitrification technique has improved the efficiency and outcome of oocyte or embryo cryopreservation programmes (Kolibianakis et al, 2009), some investigators recommended a 'freeze all' policy for all IVF patients (Barnhart, 2014;Shapiro et al, 2014aShapiro et al, , 2014bWeinerman and Mainigi, 2014). This concept has also been suggested after GnRHa trigger in view of concerns about the abnormal luteal phase (Atkinson et al, 2014;Devroey et al, 2011;Garcia-Velasco, 2012;Griesinger et al, 2010Griesinger et al, , 2011aGriesinger et al, , 2011bHerrero et al, 2011;Manzanares et al, 2010). It is, therefore, essential that a highly successful oocyte and embryo cryopreservation programme is in place in all centres for this approach to be successful and widely accepted.…”

Section: Improved Performance Of Embryo Cryopreservation Programmesmentioning

confidence: 99%

GnRH agonist trigger for the induction of oocyte maturation in GnRH antagonist IVF cycles: a SWOT analysis

Engmann

Benadiva

Humaıdan

2016

Reproductive BioMedicine Online

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Gonadotrophin releasing hormone agonist (GnRHa) trigger is effective in the induction of oocyte maturation and prevention of ovarian hyperstimulation syndrome during IVF treatment. This trigger concept, however, results in early corpora lutea demise and consequently luteal phase dysfunction and impaired endometrial receptivity. The aim of this strenghths, weaknesses, opportunities and threats analysis was to summarize the progress made over the past 15 years to optimize ongoing pregnancy rates after GnRHa trigger. The advantages and potential drawbacks of this type of triggering are reviewed. The current approach to the management of GnRHa trigger in autologous cycles is based on the peak serum oestradiol level or follicle number and aims at a fresh embryo transfer or a segmentation approach with elective cryopreservation policy. We recommend intensive luteal support with transdermal oestradiol and intramuscular progesterone alone if peak serum oestradiol is 4000 or more pg/ml after GnRHa trigger or dual trigger with GnRHa and HCG 1000 IU if peak serum oestradiol is less than 4000 pg/mL. On the contrary, we recommend HCG 1500 IU 35 h after GnRHa trigger if there are less than 25 follicles, or freeze all oocytes or embryos if there are over 25 follicles.

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Section: Improved Performance Of Embryo Cryopreservation Programmesmentioning

confidence: 99%

GnRH agonist trigger for the induction of oocyte maturation in GnRH antagonist IVF cycles: a SWOT analysis

Engmann

Benadiva

Humaıdan

2016

Reproductive BioMedicine Online

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“…LH peaks around 4 hours after administration and rapidly returns to its baseline value in about 20 hours. This is in sharp contrast with the natural cycle, in which it takes LH 14 hours to reach the peak, followed by a 14-hour-long plateau before returning to baseline after 48 hours ( 6 , 7 ) . Combined with the short half-life of LH, the short LH peak decreases the luteinizing stimulus on the granulosa cells, limiting the production of vascular endothelial growth factor (VEGF), which is the key mediator that leads to increased vascular permeability, the hallmark of OHSS ( 8 , 11 , 10 ) .…”

Section: Introductionmentioning

confidence: 69%

Gonadotropin-releasing hormone agonist triggering of oocyte maturation in assisted reproductive technology cycles

Türkgeldi¹,

Turkgeldi²,

Seyhan³

et al. 2015

tjod

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Gonadotropin-releasing hormone agonists (GnRHa) have gained increasing attention in the last decade as an alternative trigger for oocyte maturation in patients at high risk for ovarian hyperstimulation syndrome (OHSS). They provide a short luteinizing hormone (LH) peak that limits the production of vascular endothelial growth factor, which is the key mediator leading to increased vascular permeability, the hallmark of OHSS. Initial studies showed similar oocyte yield and embryo quality compared with conventional human chorionic gonadotropin (hCG) triggering; however, lower pregnancy rates and higher miscarriage rates were alarming in GnRHa triggered groups. Therefore, two approaches have been implemented to rescue the luteal phase in fresh transfers. Intensive luteal phase support (iLPS) involves administiration of high doses of progesterone and estrogen and active patient monitoring. iLPS has been shown to provide satisfactory fertilization and clinical pregnancy rates, and to be especially useful in patients with high endogenous LH levels, such as in polycystic ovary syndrome. The other method for luteal phase rescue is low-dose hCG administiration 35 hours after GnRHa trigger. Likewise, this method results in statistically similar ongoing pregnancy rates (although slightly lower than) to those of hCG triggered cycles. GnRHa triggering decreased OHSS rates dramatically, however, none of the rescue methods prevent OHSS totally. Cases were reported even in patients who underwent cryopreservation and did not receive hCG. GnRH triggering induces a follicle stimulating hormone (FSH) surge, similar to natural cycles. Its possible benefits have been investigated and dual triggering, GnRHa trigger accompanied by a simultaneous low-dose hCG injection, has produced promising results that urge further exploration. Last of all, GnRHa triggering is useful in fertility preservation cycles in patients with hormone sensitive tumors. In conclusion, GnRHa triggering accompanied by appropriate luteal phase rescue protocols is a relatively safe option for patients at high risk for OHSS.

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“…Thus, finding the optimum levels of LH and progesterone can be used for prediction of number of retrieved oocytes, maturity rate and fertilization rate. 12 Thus there is a shorter flare of LH and FSH as compared to natural cycles. This small duration of peak decreases luteinizing stimulus on the granulosa cells thus limiting production of vascular endothelial growth factor, reducing incidence of OHSS to almost zero.…”

Section: Baseline and Stimulation Cycle Characteristicsmentioning

confidence: 99%

Prediction of efficacy of gonadotropin releasing hormone agonist trigger for final oocyte maturation through post-trigger 12-hour luteinizing hormone, follicle stimulating hormone and progesterone levels in COS: a prospective study

Agarwal

Krishna

Pranesh

et al. 2019

Int J Reprod Contracept Obstet Gynecol

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HCG binds to LH receptor causing follicular maturation, luteinization and ovulation. It has 6-7 times increased biological activity with half life persisting upto 5-6 days. 3 ABSTRACT Background: Circulating levels of luteinizing hormone (LH), follicle stimulating hormone (FSH) and progesterone (P4) in serum after administration of gonadotropin releasing hormone agonist (GnRHa) trigger for final oocyte maturation are found to be predictive of oocyte maturity. This prospective study was conducted at a tertiary care centre to evaluate relationship between serum LH, FSH and P4 levels at 12-h post-trigger and oocyte maturity rate and to predict which hormone has maximum sensitivity and specificity for appropriate oocyte maturation. Methods: Women at risk of ovarian hyper-stimulation syndrome who underwent either autologous or donor IVF cycle treated with flexible GnRH antagonist protocol were taken as participants of the study. GnRHa as trigger for final oocyte maturation was given. After 12 hours of agonist trigger, blood sample was drawn to assess LH, FSH and P4 levels in serum. Continuous variables were expressed as mean±SD. Independent sample t test was used for continuous variables which were normally distributed and Mann-Whitney U test for data not normally distributed. Main outcome measures were number of oocytes retrieved, oocyte maturity rate, fertilization rate, cleavage rate and grade of embryos. Results: There was a statistically significant reduction in number of retrieved oocytes, maturity rate, fertilization rate and grade 1 embryos with a concentration of serum LH and P4 less than the cut off value (p < 0.05). Conclusions: Serum LH and P4 level less than the cut off value at 12-hour post-trigger with GnRHa is associated with a dramatically less oocyte maturity rate and fertilization rate.

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GnRH Agonist Triggers and their Use in Assisted Reproductive Technology: The Past, the Present and the Future

Cited by 10 publications

References 39 publications

GnRH agonist trigger for the induction of oocyte maturation in GnRH antagonist IVF cycles: a SWOT analysis

GnRH agonist trigger for the induction of oocyte maturation in GnRH antagonist IVF cycles: a SWOT analysis

Gonadotropin-releasing hormone agonist triggering of oocyte maturation in assisted reproductive technology cycles

Prediction of efficacy of gonadotropin releasing hormone agonist trigger for final oocyte maturation through post-trigger 12-hour luteinizing hormone, follicle stimulating hormone and progesterone levels in COS: a prospective study

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