Low-dose human chorionic gonadotropin versus estradiol/progesterone luteal phase support in gonadotropin-releasing hormone agonist–triggered assisted reproductive technique cycles: understanding a new approach

Garcia-Velasco, Juan A.; Motta, Leticia; López, Alberto López; Mayoral, Mercedes; Cerrillo, M.; Pacheco, A.

doi:10.1016/j.fertnstert.2010.06.035

Cited by 27 publications

(25 citation statements)

References 21 publications

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“…In fact, the mid-luteal ovarian volume is significantly reduced after GnRHa trigger compared with HCG trigger (Babayof et al, 2006;Engmann et al, 2008;Garcia-Velasco et al, 2010). Similarly, less fluid is found in the cul de sac in the mid-luteal phase after GnRHa trigger (Garcia-Velasco et al, 2010). Several randomized and retrospective studies in autologous high responders and oocyte donors previously reported the total elimination of OHSS after GnRHa trigger (Babayof et al, 2006;Bodri et al, 2011;DiLuigi et al, 2010;Engmann et al, 2008;Humaidan et al, 2011;Kol and Muchtar, 2005).…”

Section: Prevention Of Ohssmentioning

confidence: 99%

“…Hence, the defective corpus luteum formation or early corpus luteum demise results in the decrease in release of vasoactive peptides such as VEGF (Cerrillo et al, 2009(Cerrillo et al, , 2011, which per se prevent OHSS development (Bodri et al, 2011;Engmann et al, 2008;Humaidan et al, 2011). In fact, the mid-luteal ovarian volume is significantly reduced after GnRHa trigger compared with HCG trigger (Babayof et al, 2006;Engmann et al, 2008;Garcia-Velasco et al, 2010). Similarly, less fluid is found in the cul de sac in the mid-luteal phase after GnRHa trigger (Garcia-Velasco et al, 2010).…”

Section: Prevention Of Ohssmentioning

confidence: 99%

“…Multiple follicular development and a significant increase in ovarian volume and fluid retention after HCG trigger may predispose the patent to significant abdominal discomfort, bloating and pain in the luteal phase. On the contrary, GnRHa trigger results in reduced ovarian volumes (Engmann et al, 2008), less fluid in the cul de sac (Garcia-Velasco et al, 2010) and onset of early menses , which result in less abdominal discomfort and bloating after GnRHa trigger and hence an improved quality of life. In a study consisting of 39 oocyte donors, no patients complained of abdominal discomfort 1 week after GnRHa trigger compared with 42% after HCG trigger (Cerrillo et al, 2009).…”

Section: Less Patient Discomfortmentioning

confidence: 99%

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GnRH agonist trigger for the induction of oocyte maturation in GnRH antagonist IVF cycles: a SWOT analysis

Engmann

Benadiva

Humaıdan

2016

Reproductive BioMedicine Online

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Gonadotrophin releasing hormone agonist (GnRHa) trigger is effective in the induction of oocyte maturation and prevention of ovarian hyperstimulation syndrome during IVF treatment. This trigger concept, however, results in early corpora lutea demise and consequently luteal phase dysfunction and impaired endometrial receptivity. The aim of this strenghths, weaknesses, opportunities and threats analysis was to summarize the progress made over the past 15 years to optimize ongoing pregnancy rates after GnRHa trigger. The advantages and potential drawbacks of this type of triggering are reviewed. The current approach to the management of GnRHa trigger in autologous cycles is based on the peak serum oestradiol level or follicle number and aims at a fresh embryo transfer or a segmentation approach with elective cryopreservation policy. We recommend intensive luteal support with transdermal oestradiol and intramuscular progesterone alone if peak serum oestradiol is 4000 or more pg/ml after GnRHa trigger or dual trigger with GnRHa and HCG 1000 IU if peak serum oestradiol is less than 4000 pg/mL. On the contrary, we recommend HCG 1500 IU 35 h after GnRHa trigger if there are less than 25 follicles, or freeze all oocytes or embryos if there are over 25 follicles.

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Section: Prevention Of Ohssmentioning

confidence: 99%

Section: Prevention Of Ohssmentioning

confidence: 99%

Section: Less Patient Discomfortmentioning

confidence: 99%

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GnRH agonist trigger for the induction of oocyte maturation in GnRH antagonist IVF cycles: a SWOT analysis

Engmann

Benadiva

Humaıdan

2016

Reproductive BioMedicine Online

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“…In the group of patients included in our study, the choice of an intensive luteal support with progesterone plus triptorelin, instead of estrogens [20] or hCG [21], produced good effects.Our results are in line with previous data which demonstrated that repeated dose of a GnRH agonist during luteal phase recover the luteal phase deficiencyand is compatible with normal implantation and pregnancy evolution [22]. We also observed that three patients achieved pregnancy after the implantation of frozen-thawed blastocyst, and one patient achieved pregnancy after the transfer of vitrified oocytes, enhancing the pregnancy rate per stimulation.…”

Section: Discussionmentioning

confidence: 86%

“…The use of triptorelin as luteal support allows sustaining constantly small flares of endogenous pituitary gonadotropins which can stimulate and recover the function of corpora lutea [18]. At the same time, the aggressive luteal support with triptorelin appears to have a direct effect on endometrium and embryo by acting on a placental GnRH receptor [19].In the group of patients included in our study, the choice of an intensive luteal support with progesterone plus triptorelin, instead of estrogens [20] or hCG [21], produced good effects.Our results are in line with previous data which demonstrated that repeated dose of a GnRH agonist during luteal phase recover the luteal phase deficiencyand is compatible with normal implantation and pregnancy evolution [22]. We also observed that three patients achieved pregnancy after the implantation of frozen-thawed blastocyst, and one patient achieved pregnancy after the transfer of vitrified oocytes, enhancing the pregnancy rate per stimulation.…”

mentioning

confidence: 99%

The Use of Corifollitropin Alfa in Combination with a GnRH Analogue as Final Trigger in the Potential High Responders

Arnoldi¹

2014

JFIV Reprod Med Genet

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Background: A great concern exists in using corifollitropin alfa to induce ovarian stimulation in high responders due to the riskof OHSS.In this study, we utilized corifollitropin alfa in patients with the potential of being high responders, in addition to the GnRH analogue triptorelin, as final trigger to induce the oocyte maturation. An intensive luteal support was administered to allow the transfer in the same cycle. Patients and methods:Between January 2013 and September 2014, 35 patients were stimulated with corifollitropin alfa and underwent in vitro fertilization or intracytoplasmic sperm injection procedures. All women had levels of antimullerian hormone>3 ng/ml and antral follicle count >10 and <20. The patients with polycystic ovarian syndrome were excluded from the study. Results:The mean number of oocytes collected was 13.95 ± 6.04, the mean number of oocytes inseminated was 5.11 ± 1.66, the mean number of embryos obtained and transferred was 3.13 ±1.61 and 2.11 ± 0.92, respectively. All patients received a fresh embryo transfer,and the luteal phase was intensively supported by triptorelin and progesterone.A part of oocytes (2.47 ± 4.28) and blastocysts (0.39 ± 0.75) was vitrified.The clinical pregnancy was achieved in 15 patients and the ongoing pregnancy in11 women. Cumulative ongoing pregnancy rate, including the pregnancies achieved after thawing of eggs or embryos, was 39.47%. No OHSS were observed. Conclusions:Corifollitropin alfa plus triptorelin trigger elicits a safe ovarian stimulation in the potential high responderpatients. first day after insemination.Luteal phase was supportedby triptorelin 0.1 mg, one injection every other day from the embryo transfer, for a total of five injections. Additionally, 600 mg/day of micronized progesterone (Progeffik 200 mg, 3 cps/die) was started from the day of oocyte retrieval. A quantitative pregnancy test, done by dosing serum β-hCG, was performed 12 days after ovulation triggering with triptorelin and it was repeated 2 days later. In the presence of pregnancy, a transvaginal ultrasound was performed 28-32 days after the embryo transfer and repeated as required. Clinical pregnancy was confirmed if a fetal heartbeat was observed by transvaginal ultrasound. ResultsCharacteristics of ovarian stimulation and IVF/ICSI parameters are described in Table 1. Despite the patients included in this study had a high follicular response (14 women had over 15 oocytes retrieved), the ovarian stimulation protocol allowed to obtain a good fertilization rate and top-and good-quality embryos.Our results show that, in this group ofthe potential high responder patients, 15 clinical pregnancies and 11 ongoing pregnancies were achieved per fresh cycle ( Table 2). The cumulative ongoing pregnancy rate reached 39.47%, including 4 ongoing pregnancies which were obtained after the transfer of frozen-thawed oocyte (in one patient) and blastocysts (in three patients). Some of the pregnancies have already delivered the birth of a healthy baby. All patients reported good comp...

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Gonadotropin-releasing hormone agonist versus HCG for oocyte triggering in antagonist-assisted reproductive technology

Youssef

Veen

Al-Inany

et al. 2014

Cochrane Database of Systematic Reviews

253

190

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Low-dose human chorionic gonadotropin versus estradiol/progesterone luteal phase support in gonadotropin-releasing hormone agonist–triggered assisted reproductive technique cycles: understanding a new approach

Cited by 27 publications

References 21 publications

GnRH agonist trigger for the induction of oocyte maturation in GnRH antagonist IVF cycles: a SWOT analysis

GnRH agonist trigger for the induction of oocyte maturation in GnRH antagonist IVF cycles: a SWOT analysis

The Use of Corifollitropin Alfa in Combination with a GnRH Analogue as Final Trigger in the Potential High Responders

Gonadotropin-releasing hormone agonist versus HCG for oocyte triggering in antagonist-assisted reproductive technology

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