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

Combined ovulation triggering with GnRH agonist and hCG in IVF patients

“…Similarly, the use of more-aggressive luteal support after the GnRH agonist trigger, was also associated with superior reproductive outcome (50% vs. 37.8% vs. 20%, respectively) when compared with the GnRH agonist alone and standard luteal support (20,6% vs.25.3% vs.58.2%, respectively) (p<.001) with no cases of OHSS (p=.723) [11]. Since the lower pregnancy rates after the GnRH agonist trigger with peak estradiol (E2) <4,000 pg/mL and intensive luteal support were attributed to the lower LH levels on the day of trigger [23], the use of the dual trigger with GnRH agonist and low-dose hCG compared the reproductive outcome with GnRH agonist trigger alone in high responders with peak E2 <4,000 pg/mL. It appears that the dual trigger with low-dose hCG (1,000 IU) and leuprolide acetate (1 mg) combined with intensive luteal support is an effective strategy with only one case of mild OHSS and a significantly higher live birth rate (52.9% vs. 30.9%) (p=.03), implantation rate (41.9% vs. 22.1%) (p<.01) and clinical pregnancy rate (58.8% vs. 36.8%) (p=.03) compared with the GnRH agonist trigger group [12].…”

Gonadotropin Releasing Hormone Agonist Final Oocyte Maturation and Human Chorionic Gonadotropin as Exclusive Luteal Support in Normal Responders

“…However, optimal cryopreservation programs are not available worldwide, additional costs are incurred, patient satisfaction may decline and concerns are raised regarding epigenetic changes and reproductive outcomes [22]. Intense progesterone and estradiol supplementation have been proposed with conflicting results [4,16,[23][24][25][26]. Another strategy for luteal phase rescue after GnRHa triggering is adding low-dose hCG to estradiol and progesterone [27].…”

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

“…Araştırmacılar, bu çalış-manın sonuçlarına dayanarak; serum pik östradiol değeri <4.000 pg/mL olan hasta grubunda ovülas-yon tetikleme gününde GnRHa'ya 1.000 IU hCG eklemek ya da tetiklemeden 35 saat sonra (OPU gü-nünde) 1.500 IU hCG eklemekle daha iyi sonuçlar elde edilebileceğini belirtmişlerdir. 31 Bu konuyla ilgili aynı merkezden yapılan başka bir çalışmada, GnRH-A protokol ve GnRHa ile tetikleme yapılan 508 otolog ve donör IVF siklusu incelenmiştir. Bütün hastaların GnRHa tetikleme sonrası 8-12. saatler arasında LH, östradiol ve progesteron hormon seviyelerine bakılmıştır.…”