GnRH agonist triggering: recent developments

Abstract

The concept that a bolus of gonadotrophin-releasing hormone agonist (GnRHa) can replace human chorionic gonadotrophin(HCG) as a trigger of final oocyte maturation was introduced several years ago. Recent developments in the area strengthen this premise. GnRHa trigger offers important advantages, including virtually complete prevention of ovarian hyperstimulation syndrome(OHSS), the introduction of a surge of FSH in addition to the LH surge and finally the possibility to individualize luteal-phase supplementation based on ovarian response to stimulation. We maintain that the automatic HCG triggering concept should be challenged and that the GnRHa trigger is the way to move forward with thoughtful consideration of the needs, safety and comfort of our patients.

Influence of Elevated LH: FSH Ratio on IVF Outcome, Comparing the Impacts of Different Triggering Medicines

“…Liu et al demonstrated that day 3 LH/FSH ≥ 2 is associated with higher rates of cancellation of IVF cycles since there was less expecting the number of Oocytes retrieved together with very poor maturation [5]. The hypothesis in conducting the present study was to observe whether elevated day 3 LH/FSH ratio ≥ 1 and above in high response women are really impacting IVF outcome (total number of oocytes retrieved and Total matured oocytes) while using different triggering medicine for ovulation stimulation [6] (Figures 1 and 2). …”

Gonadotropin-releasing hormone agonist triggering is effective, even at a low dose, for final oocyte maturation in ART cycles: Case series

“…Thus, many studies have focused on avoiding this iatrogenic complication using various strategies (2). It is well established that this syndrome almost always requires the exogenous administration of human chorionic gonadotropin (hCG) or endogenous pregnancy-derived hCG stimulation (3). However, due to its luteinizing hormone (LH) homology, extended half-life, and simple manufacturing process, hCG is an excellent trigger for final oocyte maturation (3).…”

“…It is well established that this syndrome almost always requires the exogenous administration of human chorionic gonadotropin (hCG) or endogenous pregnancy-derived hCG stimulation (3). However, due to its luteinizing hormone (LH) homology, extended half-life, and simple manufacturing process, hCG is an excellent trigger for final oocyte maturation (3). Nevertheless, the introduction of gonadotropin-releasing hormone (GnRH) antagonist protocols has allowed the utilization of a GnRH agonist (a) to induce final oocyte maturation.…”

“…Nevertheless, the introduction of gonadotropin-releasing hormone (GnRH) antagonist protocols has allowed the utilization of a GnRH agonist (a) to induce final oocyte maturation. The GnRH agonist displaces the GnRH antagonist in the pituitary gland, activating the GnRH receptor and resulting in a surge of gonadotropins (flare-up) similar to the natural midcycle surge (3). Moreover, GnRH agonist triggering has been shown to retrieve more metaphase II (MII) oocytes compared with hCG triggering (4).…”

Uso de agonista de GnRH para inducir ovulación en ciclos de hiperestimulación ovárica controlada: Experiencia de Clínica Monteblanco, Santiago, Chile

“…La administración de un análogo de GnRH induce una rápida liberación de LH y FSH, alcanzando niveles plasmáticos similares a los fisiológicos en el momento de la ovulación (5)(6)(7)(8). Sin embargo, son muchos los centros que no lo usan por temor a que sea menos eficiente en el proceso de inducir la maduración final de los ovocitos.…”