A Rationale for Timing of Luteal Support Post Gonadotropin-Releasing Hormone Agonist Trigger

Kol, Shahar

doi:10.1159/000491088

Cited by 6 publications

(3 citation statements)

References 26 publications

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“…Despite data on its efficacy and safety, it has been recognized that GnRH-a triggering may not result in an adequate oocyte yield and has an adverse impact on pregnancy outcomes in patients with low LH on the triggering day [18,[53][54][55] . GnRH-as trigger the release of endogenous LH from the pituitary gland and cause rapid luteolysis, leading to luteal phase deficiency [56,57] . Therefore, patients with low LH levels may not be suitable candidates for treatment with GnRH-as.…”

Section: Discussionmentioning

confidence: 99%

Association between luteinizing hormone level decrease on the triggering day and pregnancy outcome for in vitro fertilization/intracytoplasmic sperm injection patients following gonadotropin-releasing hormone antagonist protocol: a retrospective cohort study

Tang

Wang

et al. 2023

Reproductive and Developmental Medicine

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Objective: Optimal luteinizing hormone (LH) levels for in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) patients following the gonadotropin-releasing hormone (GnRH) antagonist protocol remain controversial. This study aimed to estimate the association between serum LH levels on the triggering day (LHLOT) and clinical pregnancy outcomes in IVF/ICSI patients following the GnRH antagonist protocol. Methods: We enrolled 4743 IVF/ICSI cycles using flexible or fixed GnRH antagonist protocols between January 2017 and June 2021. The patients were stratified into four groups according to the LHLOT quartiles (Q1–Q4). Each group was further divided into two subgroups according to the median basal LH/LHLOT. The main outcomes were clinical pregnancy, birth, and miscarriage rates. Secondary outcomes were oocyte yield, number of MII, fertilized oocytes (2PN), and high-quality embryos. Results: Serum LHLOT levels were negatively correlated with oocyte yield and the numbers of MII, 2PN, and high-quality embryos. Reproductive outcomes were compared among the different quartiles and subgroups. The absolute difference in the clinical pregnancy rates between the Q4 and Q1 groups was 6.4% (47.2% vs. 40.8%, P <0.05). Clinical pregnancy rates between the subgroups with basal LH/LHLOT >3.04 and ≤3.04 were 32.7% and 48.6% (P <0.01), respectively, in Q1. Within Q3, the clinical pregnancy rates between the subgroups with basal LH/LHLOT >2.14 and ≤2.14 were 50.2% and 41.9%, respectively (P <0.05). The greater the decrease in LH levels, the lower the oocyte maturation rate across all quartiles. Conclusions: According to the LHLOT quartiles, the Q1 of serum LHLOT <1.43 IU/L may result in a higher number of oocytes but reduced oocyte maturation and lower clinical pregnancy rates. A decrease in LH levels by approximately 2.14 to 3.04 times compared to basal LH levels may lead to higher clinical pregnancy rates in IVF/ICSI patients following the GnRH antagonist protocol.

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Section: Discussionmentioning

confidence: 99%

Association between luteinizing hormone level decrease on the triggering day and pregnancy outcome for in vitro fertilization/intracytoplasmic sperm injection patients following gonadotropin-releasing hormone antagonist protocol: a retrospective cohort study

Tang

Wang

et al. 2023

Reproductive and Developmental Medicine

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“…A large number of studies (4,5) at home and abroad have shown that the application of the gonadotropin-releasing hormone agonist (GNRH-a) during chemotherapy has a protective effect on the ovarian function of cervical cancer patients who undergo the TP chemotherapy regimen (6). Cervical cancer is a common clinical gynecological disease.…”

Section: Original Articlementioning

confidence: 99%

Ovarian protection and safety of gonadotropin-releasing hormone agonist after cervical cancer surgery: systematic review and meta-analysis

Yuan¹,

Lai²,

Li³

2022

Ann Transl Med

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Background: This meta-analysis was performed using Stata (15.0), and sought to systematically evaluate the domestic application value of the gonadotropin-releasing hormone agonist (GNRH-a) after cervical cancer, and explore its protective effect on the ovaries during chemotherapy. In many studies, the effectiveness and safety of GNRH-a are not consistent, and there is great controversy. Therefore, it is very important to systematically evaluate the protection and safety of GNRH-a after cervical cancer surgery.Methods: PubMed, Cochrane Library, and Web of Science databases were systematically searched to retrieve articles on domestic trials examining the use of GNRH-a treatment in cervical cancer patients, published from January 2014 to January 2021, which were reviewed according to the inclusion and exclusion criteria of this study. The meta-analysis of the included study data was conducted using Stata 15.0.Results: In total, 10 articles were included in the meta-analysis, comprising 579 ovarian-reserved cervical cancer subjects, all of whom received 4-6 standardized courses of PC (Paclitaxel + Cisplatin) chemotherapy.The following statistically significant differences were found: bovine follicle stimulating hormone [odds

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“…Recently, several publications examined cycles that were triggered with a GnRH agonist to reduce the risk for OHSS, but that subsequently proceeded with a fresh ET. The challenges in designing LPS post GnRH agonist are the higher chances for rapid luteolysis on one hand, and the need to reduce the risk for OHSS on the other ( 15 ). Elgindy et al ( 16 ) conducted a RCT comparing IM vs. vaginal progesterone administration in patients with increased baseline OHSS risk that were triggered with either GnRH agonist or 5,000 IU of HCG.…”

Section: Introductionmentioning

confidence: 99%

Luteal phase support in fresh and frozen embryo transfers

Greenbaum

Athavale

Klement

et al. 2022

Front. Reprod. Health

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ContextLuteal phase support (LPS) has become an essential component of IVF protocols following both fresh and frozen embryo transfers, yet there is still controversy with regards to the optimal protocol of LPS to enhance treatment outcome.Search strategyA search via PubMed for all the selected topics was limited to publications from the past 10 years and to English language. We subsequently searched the reference lists of retrieved articles. Where available, RCTs were chosen over non-randomized studies. Here we provide an updated review of the current literature on various issues relating to LPS, in both fresh and frozen embryo transfers. The timing of LPS initiation as well as the route of administration and dosing are discussed for both fresh and frozen transfers. A separate discussion for frozen thawed embryo transfer in natural cycles and non-ovulatory cycles is presented.ConclusionsWe present data that supports the use of Progesterone LPS in fresh and frozen embryo transfers. No benefits were found to the addition of hCG or estradiol to progesterone LPS in fresh transfers, however GnRH agonist may have a role. IM Progesterone was not advantageous over vaginal progesterone in fresh transfers but was superior in frozen transfers. The timing of LPS introduction, the interval to embryo transfer, as well as the serum concentration of progesterone, have significant effects on the success of the treatment.

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A Rationale for Timing of Luteal Support Post Gonadotropin-Releasing Hormone Agonist Trigger

Cited by 6 publications

References 26 publications

Association between luteinizing hormone level decrease on the triggering day and pregnancy outcome for in vitro fertilization/intracytoplasmic sperm injection patients following gonadotropin-releasing hormone antagonist protocol: a retrospective cohort study

Association between luteinizing hormone level decrease on the triggering day and pregnancy outcome for in vitro fertilization/intracytoplasmic sperm injection patients following gonadotropin-releasing hormone antagonist protocol: a retrospective cohort study

Ovarian protection and safety of gonadotropin-releasing hormone agonist after cervical cancer surgery: systematic review and meta-analysis

Luteal phase support in fresh and frozen embryo transfers

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