Cycles triggered with GnRH agonist: exploring low-dose HCG for luteal support

Abstract

The aim of this study in patients at risk of ovarian hyperstimulation syndrome (OHSS) was to determine the efficacy and safety of luteal support using human chorionic gonadotrophin (HCG) after triggering ovulation with gonadotrophin-releasing hormone (GnRH) agonist in IVF/intracytoplasmic sperm injection antagonist cycles. A total of 192 OHSS-risk patients, following a GnRH antagonist protocol (0.25mg/day cetrorelix) during recombinant FSH stimulation, were triggered with 1.5mg s.c. leuproreline for ovulation. A total of three boluses of HCG were used for luteal support, 1000IU (group A, n=44), 500IU (group B, n=115) or 250IU (group C, n=33) every third day, starting the day after oocyte retrieval. For the reproductive outcome, main variables were biochemical and clinical pregnancy rates, and for OHSS, the variables were the numbers of moderate and severe OHSS cases. Overall pregnancy rate was 51.8% and clinical pregnancy rate was 43.4%. This study observed eight cases of moderate (4.2%) and seven of severe OHSS (3.6%). Six out of the seven (85.7%) severe cases were late-onset OHSS, related to pregnancy. In conclusion, GnRH agonist single dose for triggering ovulation and low doses of HCG used as luteal-phase support seem to secure a normal pregnancy outcome without increasing the OHSS risk.

Factors that predict the probability of a successful clinical outcome after induction of oocyte maturation with a gonadotropin-releasing hormone agonist

“…Adjuvant LH supplementation after a GnRH-agonist trigger has been administered in the form of a dual GnRH-agonist and lowdose hCG trigger (24), a low-dose hCG administered either 35 hours after a GnRH-agonist trigger (25,26) or intermittently during the luteal phase (27), and intermittent luteal phase recombinant LH administration (28). The main concern regarding the use of adjuvant low-dose hCG or recombinant LH is the potential recovery of CL function, which may increase the risk of OHSS development.…”

Current Medical Strategies in the Prevention of Ovarian Hyperstimulation Syndrome

“…Although diff erent GnRH agonists have been used in GnRH antagonist cycles for the fi nal oocyte maturation in high-responders, no universal consensus has been defi ned regarding the optimal agonist kind and dose, and there is no report evaluating the impact of diff erent agonists on cycle outcomes. Among various GnRH agonists, buserelin 0.5 mg 14 , triptorelin 0.2 mg 15,16 and leuprolide acetate (0.5-4 mg) 17,18 have been utilized and almost all studies compared the outcomes of GnRH agonist triggered cycles with the cycles triggered with hCG. Most previous studies have reported successful oocyte maturation with 0.2-0.3 mg triptorelin, 0.5 mg buserelin and 1 mg leuprolide acetate [14][15][16]19 .…”

Current Approaches to the Use of GnRH Agonist Trigger for Final Oocyte Maturation: Review

“…Ancak, %4,1 oranında orta ve %3,6 oranında ciddi OHSS komplikasyonları oluş-muştur. 22 Humaidan ve ark., yaptıkları birkaç ça-lışmada hem normo-responder hem de high-responder hastalarda yapılan GnRHa tetikleme sonrası HCG kullanımının reprodüktif sonuçları normalize ettiğini bildirmişlerdir. 16,17,23 Humaidan ve ark.…”