GnRH agonist for final oocyte maturation in GnRH antagonist co-treated IVF/ICSI treatment cycles: Systematic review and meta-analysis

Youssef, Mohamed; Abdelmoty, Hatem I.; Ahmed, Mohamed A Sayed; Elmohamady, Maged

doi:10.1016/j.jare.2015.01.005

Cited by 22 publications

(12 citation statements)

References 28 publications

(77 reference statements)

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“…[ 47 ] In a recent systematic review and meta-analysis by Youssef et al . 2015,[ 54 ] GnRHa seem to be safer than traditional hCG due to the associated low risk of OHSS in fresh autologous cycles (ten RCTs, OR: 0.06, 95% CI: 0.02–0.19). [ 54 ] However, majority of studies evaluated the role of GnRHa in normoresponders with normal to low risk of developing OHSS.…”

Section: Discussionmentioning

confidence: 99%

“…2015,[ 54 ] GnRHa seem to be safer than traditional hCG due to the associated low risk of OHSS in fresh autologous cycles (ten RCTs, OR: 0.06, 95% CI: 0.02–0.19). [ 54 ] However, majority of studies evaluated the role of GnRHa in normoresponders with normal to low risk of developing OHSS. The role of agonist trigger in terms of OHSS incidence was further elucidated used the donor-recipient model in randomized clinical trials and none of the patients developed OHSS whereas the OHSS incidence after hCG triggering was between 4% and 17%.…”

Section: Discussionmentioning

confidence: 99%

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Gonadotropin-releasing hormone agonist trigger is a better alternative than human chorionic gonadotropin in PCOS undergoing IVF cycles for an OHSS Free Clinic: A Randomized control trial

Krishna¹,

Snehal²,

Gautham³

et al. 2016

J Hum Reprod Sci

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OBJECTIVE:The objective of this study is to evaluate if gonadotropin-releasing hormone agonist (GnRHa) trigger is a better alternative to human chorionic gonadotropin (hCG) in polycystic ovary syndrome (PCOS) of Indian origin undergoing in vitro fertilization (IVF) cycles with GnRH antagonist for the prevention of ovarian hyperstimulation syndrome (OHSS).DESIGN:Prospective randomized control trial.SETTING:Tertiary care center.MATERIALS AND METHODS:A total of 227 patients diagnosed with PCOS, undergoing IVF in an antagonist protocol were recruited and randomly assigned into two groups: Group A (study group): GnRHa trigger 0.2 mg (n = 92) and Group B (control group): 250 μg of recombinant hCG as trigger (n = 101) 35 h before oocyte retrieval. We chose segmentation strategy, freezing all embryos in both the groups.STATISTICAL ANALYSIS:Continuous variables were expressed as mean ± standard deviation independent sample t-test and Kolmogorov-Smirnov test were used for continuous variables which were normally distributed and Mann-Whitney U-test for data not normally distributed.MAIN OUTCOME MEASURES:Primary outcome: OHSS (mild, moderate, and severe) rates. Secondary outcomes: Maturity rate of the oocytes, fertilization rate, availability of top quality embryos on day 3 (Grade 1 and Grade 2).RESULTSThe incidence of moderate to severe OHSS in the hCG group was 37.6% and 0% in the GnRHa group with P < 0.001. The GnRHa group had significantly more mature oocytes retrieved (19.1 ± 11.7 vs. 14.1 ± 4.3), more fertilized oocytes (15.6 ± 5.6 vs. 11.7 ± 3.6), and a higher number of top quality cleavage embryos on day 3 (12.9 ± 4.7 vs. 7.5 ± 4.3) than the hCG group.CONCLUSIONS:The most effective strategy which significantly eliminates the occurrence of OHSS in PCOS following ovarian stimulation in antagonist IVF cycles is the use of GnRHa trigger yielding more mature oocytes and good quality embryos when compared with hCG trigger.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Gonadotropin-releasing hormone agonist trigger is a better alternative than human chorionic gonadotropin in PCOS undergoing IVF cycles for an OHSS Free Clinic: A Randomized control trial

Krishna¹,

Snehal²,

Gautham³

et al. 2016

J Hum Reprod Sci

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“…The standard protocol for stimulation is the antagonist protocol with ovulation induction using GnRH agonists (triptorelin 0.2 mg s.c.) to minimize the risk of ovarian hyperstimulation syndrome (OHSS) [ 16 ].…”

Section: Ovarian Stimulation and Freezing Of Oocytesmentioning

confidence: 99%

Practical recommendations for fertility preservation in women by the FertiPROTEKT network. Part II: fertility preservation techniques

Wolff

Germeyer

Liebenthron

et al. 2017

Arch Gynecol Obstet

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PurposeIn addition to guidelines focusing on scientific evidence, practical recommendations on fertility preservation are also needed.MethodsA selective literature search was performed based on the clinical and scientific experience of the authors. This article (Part II) focuses on fertility preservation techniques. Part I, also published in this journal, provides information on disease prognosis, disease-specific therapy, and risks for loss of fertility.ResultsOvarian stimulation including double stimulation and freezing of oocytes is the best-established therapy providing live birth chances in women < 35 years with high ovarian reserve of around 30–40%. Ovarian tissue freezing is especially useful in young women with good ovarian, if spontaneous conception is favoured and if < 1 week until chemotherapy is provided. Data on success rates are still limited, but this further evolving technique will possibly reach similar success rates as ovarian stimulation. GnRH agonists seem to reduce the risk of premature ovarian failure up to 50%; however, the effect is possibly not long-lasting. Ovarian transposition can easily be combined with freezing of ovarian tissue and is the preferred technique before pelvic radiotherapy. Other techniques, such as in vitro maturation, are limited to women with high ovarian reserve and remain less effective. In addition, procedures such as in vitro growth of follicles, etc. are still experimental.ConclusionsFertility preservation in women provides realistic chances of becoming pregnant. The choice of technique needs to be based on the time required, the woman’s age, its risks and efficacy, and the individual preference of the patient.

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“…Unlike hCG triggering of final oocyte maturation, GnRHa triggering is a more physiological approach, eliciting a surge of gonadotropins similar to that of the natural mid-cycle surge [ 6 ]. The serum LH and follicle-stimulating hormone (FSH) levels rise after 4 and 12 h, respectively, and are elevated for 24–36 h. The amplitudes of the surge are similar to those observed during the normal menstrual cycle [ 7 ]. However, hCG-mediated LH activity persists for several days into the luteal phase [ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

GnRH agonist triggering affects the kinetics of embryo development: a comparative study

Gürbüz¹,

Göde

Uzman³

et al. 2016

J Ovarian Res

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BackgroundTo evaluate the effects of an ovulation triggering agent, human chorionic gonadotropin (hCG), versus a gonadotropin-releasing hormone agonist (GnRHa) on early embryo development in vitro using a time-lapse system.MethodsRetrospective analysis of a prospectively collected database. A total of 739 embryos from 152 infertile couples undergoing intracytoplasmic sperm injection cycles.Interventions : Embryo culture in a time-lapse incubator (EmbryoScope, Vitrolife, Göteborg, Sweden). Main Outcome Measures: Embryo morphokinetic parameters.ResultsIn the 152 women, 252 embryos were derived from GnRHa-triggered cycles compared with 487 embryos derived from hCG-triggered cycles. Time-lapse analysis revealed that embryos from cycles triggered by a GnRHa cleaved faster than embryos derived from hCG-triggered cycles.ConclusionTriggering with a GnRHa in in vitro fertilization cycles affects embryo kinetics.

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GnRH agonist for final oocyte maturation in GnRH antagonist co-treated IVF/ICSI treatment cycles: Systematic review and meta-analysis

Abstract: Graphical abstract

Cited by 22 publications

References 28 publications

Gonadotropin-releasing hormone agonist trigger is a better alternative than human chorionic gonadotropin in PCOS undergoing IVF cycles for an OHSS Free Clinic: A Randomized control trial

Gonadotropin-releasing hormone agonist trigger is a better alternative than human chorionic gonadotropin in PCOS undergoing IVF cycles for an OHSS Free Clinic: A Randomized control trial

Practical recommendations for fertility preservation in women by the FertiPROTEKT network. Part II: fertility preservation techniques

GnRH agonist triggering affects the kinetics of embryo development: a comparative study

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