Clinical parameters of ovarian hyperstimulation syndrome following different hormonal triggers of oocyte maturation in <scp>IVF</scp> treatment

Abbara, Ali; Islam, Rumana; Clarke, Sophie; Jeffers, L.; Christopoulos, Georgios; Comninos, Alexander; Salim, Rehan; Lavery, Stuart; Vuong, Lan N; Humaıdan, Peter; Kelsey, Tom; Trew, Geoffrey; Dhillo, Waljit S.

doi:10.1111/cen.13569

Cited by 27 publications

(28 citation statements)

References 38 publications

(98 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

Section: Ohss Following Different Agents That Induce Oocyte Maturatiomentioning

confidence: 99%

“…A single center retrospective cohort study compared clinical parameters of OHSS in hCG (n = 40), GnRHa (n = 99), or kisspeptin-54 (n = 122) in women at risk for OHSS identified by AFC >23 or total number of follicles on day of trigger >23 ( 314 ). Women had a median of 38 antral follicles, 24 follicles ≥11 mm on the day of trigger, and 19 oocytes retrieved ( 314 ). Median ovarian volume at 3 to 5 days after oocyte retrieval was larger following hCG (138 mL) than GnRHa (73 mL; P < 0.0001), and in turn kisspeptin (44 mL; P < 0.0001) ( 314 ).…”

Section: Ohss Following Different Agents That Induce Oocyte Maturatiomentioning

confidence: 99%

“…Women had a median of 38 antral follicles, 24 follicles ≥11 mm on the day of trigger, and 19 oocytes retrieved ( 314 ). Median ovarian volume at 3 to 5 days after oocyte retrieval was larger following hCG (138 mL) than GnRHa (73 mL; P < 0.0001), and in turn kisspeptin (44 mL; P < 0.0001) ( 314 ). Median ovarian volume remained enlarged 20-fold following hCG, 8-fold following GnRHa, and 5-fold following kisspeptin compared with prestimulation ovarian volumes ( 314 ).…”

Section: Ohss Following Different Agents That Induce Oocyte Maturatiomentioning

confidence: 99%

See 2 more Smart Citations

Novel Concepts for Inducing Final Oocyte Maturation in In Vitro Fertilization Treatment

2018

View full text Add to dashboard Cite

Infertility affects one in six of the population and increasingly couples require treatment with assisted reproductive techniques. In vitro fertilization (IVF) treatment is most commonly conducted using exogenous FSH to induce follicular growth and human chorionic gonadotropin (hCG) to induce final oocyte maturation. However, hCG may cause the potentially life-threatening iatrogenic complication “ovarian hyperstimulation syndrome” (OHSS), which can cause considerable morbidity and, rarely, even mortality in otherwise healthy women. The use of GnRH agonists (GnRHas) has been pioneered during the last two decades to provide a safer option to induce final oocyte maturation. More recently, the neuropeptide kisspeptin, a hypothalamic regulator of GnRH release, has been investigated as a novel inductor of oocyte maturation. The hormonal stimulus used to induce oocyte maturation has a major impact on the success (retrieval of oocytes and chance of implantation) and safety (risk of OHSS) of IVF treatment. This review aims to appraise experimental and clinical data of hormonal approaches used to induce final oocyte maturation by hCG, GnRHa, both GnRHa and hCG administered in combination, recombinant LH, or kisspeptin. We also examine evidence for the timing of administration of the inductor of final oocyte maturation in relationship to parameters of follicular growth and the subsequent interval to oocyte retrieval. In summary, we review data on the efficacy and safety of the major hormonal approaches used to induce final oocyte maturation in clinical practice, as well as some novel approaches that may offer fresh alternatives in future.

show abstract

Section: Ohss Following Different Agents That Induce Oocyte Maturatiomentioning

confidence: 99%

Section: Ohss Following Different Agents That Induce Oocyte Maturatiomentioning

confidence: 99%

Section: Ohss Following Different Agents That Induce Oocyte Maturatiomentioning

confidence: 99%

See 1 more Smart Citation

Novel Concepts for Inducing Final Oocyte Maturation in In Vitro Fertilization Treatment

2018

View full text Add to dashboard Cite

show abstract

“…30 Kisspeptin reduced the odds of severe OHSS by 33.6-fold (95% CI: 12.6-89.5) compared with hCG. 31 More recently, kisspeptin has been hypothesized to play a direct role in the pathogenesis of OHSS, by directly reducing estradiol-induced VEGF production. 32 This is consistent with clinical data, suggesting that extending the duration of the LH surge with a second dose of kisspeptin further enhances oocyte maturation, but without causing OHSS.…”

Section: Kisspeptin During In Vitro Fertilizationmentioning

confidence: 99%

Clinical Translational Studies of Kisspeptin and Neurokinin B

Hunjan

Abbara

2019

Semin Reprod Med

View full text Add to dashboard Cite

Kisspeptin and neurokinin B (NKB) are hypothalamic neuropeptides that are vital for reproductive health. An absence of either kisspeptin or NKB signaling results in hypogonadotrophic hypogonadism and a failure to proceed through puberty. In recent years, several studies have demonstrated potential avenues for the clinical utility of medications that act through these pathways in the assessment and treatment of reproductive disorders. Kisspeptin acts to stimulate hypothalamic gonadotrophic-releasing hormone (GnRH) secretion from the hypothalamus. Kisspeptin induces gonadotrophin secretion in both healthy men and women, and in women with reproductive disorders such as hypothalamic amenorrhea (HA). Kisspeptin-based treatments hold promise for use during in vitro fertilization (IVF) treatment; a bolus of kisspeptin-54 induces an LH surge of 12 to 14 hours of duration sufficient to induce oocyte maturation, but with markedly reduced rates of the most significant complication of IVF treatment, ovarian hyperstimulation syndrome (OHSS). Kisspeptin could also be used chronically to restore reproductive health in patients with functional hypogonadism, such as those with HA. Furthermore, kisspeptin has potential as a diagnostic test of hypothalamic function; a “kisspeptin test” could be used in children with delayed puberty to identify the subset with genetically determined deficits in hypothalamic pathways (congenital hypogonadotrophic hypogonadism [CHH]). In addition to its role in hypothalamic GnRH pulse generation, NKB plays a critical role in the occurrence of one of the most troubling symptoms of the menopause, the “hot flush.” Neurokinin-3 receptor (NK3R) antagonists are highly effective as treatments for hot flushes in postmenopausal women, with several compounds now in late-phase development. Furthermore, NK3R antagonism leads to a reduction in LH secretion by reducing GnRH pulsatility in the hypothalamus and has been shown to reduce androgen levels in women with polycystic ovary syndrome (PCOS) (in whom GnRH pulsatility is often increased). In summary, although further detailed evaluation in several clinical settings is ongoing, medications based on kisspeptin and NKB pathways have prodigious potential in the assessment and treatment of reproductive disorders.

show abstract

“…Not all GnRH receptors on pituitary gonadotrophs are contiguous with GnRH neuronal terminals, and thus kisspeptin induces a tempered LH rise compared to equimolar doses of GnRH ( 15 ). Indeed, kisspeptin induced even fewer signs and symptoms of OHSS in women at increased risk of OHSS ( 16 ). This may in part be mediated through an additional direct ovarian action to reduce ovarian vascular endothelial growth factor (VEGF) production ( 13 ).…”

Section: Introductionmentioning

confidence: 99%

Endocrine Requirements for Oocyte Maturation Following hCG, GnRH Agonist, and Kisspeptin During IVF Treatment

Abbara

Hunjan

et al. 2020

Front. Endocrinol.

View full text Add to dashboard Cite

Objective The maturation of oocytes to acquire competence for fertilization is critical to the success of in vitro fertilization (IVF) treatment. It requires LH-like exposure, provided by either human chorionic gonadotropin (hCG), or gonadotropin releasing hormone agonist (GnRHa). More recently, the hypothalamic stimulator, kisspeptin, was used to mature oocytes. Herein, we examine the relationship between the endocrine changes following these agents and oocyte maturation. Design Retrospective cohort study. Methods Prospectively collected hormonal data from 499 research IVF cycles triggered with either hCG, GnRHa, or kisspeptin were evaluated. Results HCG-levels (121 iU/L) peaked at 24 h following hCG, whereas LH-levels peaked at ~4 h following GnRHa (140 iU/L), or kisspeptin (41 iU/L). HCG-levels were negatively associated with body-weight, whereas LH rises following GnRHa and kisspeptin were positively predicted by pre-trigger LH values. The odds of achieving the median mature oocyte yield for each trigger were increased by hCG/LH level. Progesterone rise during oocyte maturation occurred precipitously following each trigger and strongly predicted the number of mature oocytes retrieved. Progesterone rise was positively associated with the hCG-level following hCG trigger, but negatively with LH rise following all three triggers. The rise in progesterone per mature oocyte at 12 h was greater following GnRHa than following hCG or kisspeptin triggers. Conclusion The endocrine response during oocyte maturation significantly differed by each trigger. Counter-intuitively, progesterone rise during oocyte maturation was negatively associated with LH rise, even when accounting for the number of mature oocytes retrieved. These data expand our understanding of the endocrine changes during oocyte maturation and inform the design of future precision-triggering protocols.

show abstract

Clinical parameters of ovarian hyperstimulation syndrome following different hormonal triggers of oocyte maturation in IVF treatment

Cited by 27 publications

References 38 publications

Novel Concepts for Inducing Final Oocyte Maturation in In Vitro Fertilization Treatment

Novel Concepts for Inducing Final Oocyte Maturation in In Vitro Fertilization Treatment

Clinical Translational Studies of Kisspeptin and Neurokinin B

Endocrine Requirements for Oocyte Maturation Following hCG, GnRH Agonist, and Kisspeptin During IVF Treatment

Contact Info

Product

Resources

About