Euploidy rates between cycles triggered with gonadotropin-releasing hormone agonist and human chorionic gonadotropin

Abstract

Objective: To evaluate differences in euploidy rates between IVF cycles triggered with either GnRH agonist (GnRHa) or hCG. Design: Retrospective cohort study. Setting: University-affiliated fertility center. Patient(s): A total of 366 patients performing 539 IVF cycles utilizing preimplantation genetic testing for aneuploidy (PGT-A). Intervention(s): Gonadotropin-releasing hormone agonist or hCG trigger of oocyte maturation during IVF cycles. Main Outcome Measure(s): Rate of euploid embryos. Result(s): Patients in the GnRHa trigger arm were younger, with a lower body mass index and higher antim€ ullerian hormone level, and they had a higher number of oocytes retrieved and embryos biopsied. Euploid rate per embryo biopsied was higher after GnRHa trigger than after hCG trigger (37.8% AE 2.1% vs. 30.3% AE 1.8%), but multivariate regression analysis controlling for potential confounding factors did not show any differences between the two groups. Moreover, the euploid rate per oocyte retrieved was not significantly different overall (GnRHa vs. hCG: 33.9% AE 2.2% vs. 28.0% AE 1.9%). The anticipated decline in the rate of euploid embryos per oocyte retrieved went from 15.8% AE 1.2% for age <35 years to 4.3% AE 0.9% for patients aged R41 years. There were no significant differences between the two groups after stratifying by age and controlling for PGT-A testing modality. Conclusion(s): Both GnRHa and hCG trigger result in comparable euploid rates. Trigger with GnRHa should therefore be considered a valid option for trigger modality in freeze-all PGT-A cycles, in view of its demonstrated effectiveness and known safety enhancement. (Fertil Steril Ò 2019;112:258-65. Ó2019 by American Society for Reproductive Medicine.) El resumen está disponible en Español al final del artículo.

Maternal Antimüllerian Hormone as a Predictor of Euploid Is Independently Associated With Cumulative Live Birth Rates

“…In our study, women who attained more euploidy blastocysts was found to have increased serum AMH concentration. This was in line with ndings by Antonio La Marca et al which indicates that independently from age, increased ovarian reserve is in accordance with an increased rate of embryo aneuploidy [5,18,19]. In addition,This conclusion could explain that after a unilateral oophorectomy (reduced ovarian reserve) in female mice, the number of aneuploidy (low-quality oocytes) will rise earlier than expected [20].…”

Gonadotropin-releasing hormone agonist ovulation trigger—beyond OHSS prevention

“…As observed previously, the surge of gonadotrophins elicited by a bolus of GnRHa differs from that of the natural midcycle of gonadotrophins in duration and profile. It has also been shown that the elicited flare of LH as well as FSH resembles the natural midcycle surge of gonadotrophins and was found to effectively stimulate final oocyte maturation and ovulation (10), leading to the development of competent embryos as recently demonstrated in PGT-A cycles (11). Moreover, studies in oocyte donors (12) and oncologic fertility-preservation patients (13,14) demonstrated a significant increase in MII oocytes and the number of good-quality embryos in GnRHa-triggered cycles as compared with hCGtriggered cycles.…”

Effect of a dual trigger on oocyte maturation in young women with decreased ovarian reserve for the purpose of elective oocyte cryopreservation

“…Although we cannot provide results for embryo quality according to the trigger method, the reproductive outcomes of oocytes treated with a dual-trigger approach do not seem to be compromised. Thorne et al [20] recently reported that the embryo aneuploidy rate was similar in patients stimulated with a GnRH agonist trigger and patients administered an hCG trigger. Embryo development and quality appear to be unaffected in GnRH agonist trigger cycles [21].…”