GnRH agonist versus recombinant HCG in an oocyte donation programme: a randomized, prospective, controlled, assessor-blind study

Abstract

The use of gonadotrophin-releasing hormone (GnRH) agonists for triggering ovulation remains controversial. The primary objective of this study was to evaluate the incidence of ovarian hyperstimulation syndrome (OHSS) following GnRH agonist versus recombinant human chorionic gonadotrophin (HCG) as methods for triggering ovulation. A second aim was to compare the clinical outcome and embryo quality according to the two procedures. The cycle characteristics of 100 oocyte donors undergoing ovarian stimulation and IVF outcomes of their 100 oocyte recipients were analysed. Donors were prospectively randomized into two groups on the last day of ovarian stimulation: Group I received a single bolus of 0.2 mg of triptorelin and Group II received 250 microg of recombinant HCG. No differences were observed in the number of oocytes retrieved or in the proportion of metaphase II oocytes between the groups. The OHSS rate was higher in donors that received recombinant HCG ( P = 0.003). Moreover, there was no significant difference between IVF parameters and outcome in the two groups. In conclusion, a GnRH agonist effectively triggers the final oocyte maturation in oocyte donors without negatively affecting implantation, pregnancy or miscarriage rates. Moreover, this regime effectively eliminates the risk of OHSS in this group of women.

Levels of the epidermal growth factor-like peptide amphiregulin in follicular fluid reflect the mode of triggering ovulation: a comparison between gonadotrophin-releasing hormone agonist and urinary human chorionic gonadotrophin

“…Interestingly, more MII oocytes and good available embryos after GnRH-a triggering also were reported in a recent study in women with breast cancer (22). However, an increase in the number of MII oocytes and transferable embryos was not reported in a recent randomized controlled trial comparing GnRH-a triggering with hCG triggering in oocyte donors (23), a fact that could rely on differences in the type and dose of GnRH-a used.…”

Embryo quality, blastocyst and ongoing pregnancy rates in oocyte donation patients whose embryos were monitored by time-lapse imaging

“…In all donors, ovarian stimulation was achieved by pituitary desensitization using a GnRH analogue followed by stimulation with gonadotrophins [10]. The daily dose of FSH was adjusted according to the donor's ovarian response based on serum estradiol levels and the number and size of ovarian follicles as considered by transvaginal ultrasonography.…”

Ovarian hyperstimulation syndrome after gonadotropin-releasing hormone agonist triggering and “freeze-all”: in-depth analysis of genetic predisposition

“…However, hCG has a substantially longer half-life (over 24 h versus approximately 60 min for LH) and its administration seems to play a key-role in the development of OHSS [7]. For this reason, many authors have proposed to replace hCG with a gonadotropin-releasing hormone (GnRH) agonist for triggering [4,[8][9][10][11][12][13]. In a GnRH antagonist co-treated cycle, the GnRH agonist causes the displacement of the GnRH antagonist from the pituitary receptors, resulting in a LH flare-up/Bsurget hat lasts for approximately 24-36 h [7].…”