Ovulation induction and luteal support with GnRH agonist in patients at high risk for hyperstimulation syndrome

Abstract

The aim of this study was to compare GnRHa trigger and luteal addition of triptorelin to hCG trigger for final oocyte maturation in women at high risk for OHSS undergoing IVF. A total of 423 patients were divided in two groups both stimulated using antagonist short protocol. Gonadotropins 75-150 UI/day were started on day 2-5, GnRH antagonist was added when the lead follicle was >14 mm and the final trigger was obtained with hCG 250 µg or triptorelin 0.2 mg. The luteal phase was supported with progesterone alone in the hCG group, with progesterone plus triptorelin 0.1 every other day from embryo transfer in the triptorelin group. In the triptorelin group we did neither have to suspend any embryo transfer, nor we have any early clinical OHSS. In the control group, 13 patients were suspended due to symptomatic high risk for OHSS and two patients developed a clinically significant OHSS. No statistically significant difference was observed in terms of clinical and ongoing pregnancy rates and implantation rates. Our results indicate that a protocol including GnRHa as trigger and an intensive luteal phase supported with GnRHa is safer than a standard antagonist protocol using hCG as trigger. It displays similar results, therefore it can be used as the first choice in patients at high risk for OHSS.

GnRH agonists to sustain the luteal phase in antagonist IVF cycles: a randomized prospective trial

“…It may be postulated that the beneficial effect of midluteal GnRH supplementation is further augmented by repeated GnRHa administration, as suggested by a recent study of the same group [10]. Fusi et al also demonstrated that the use of five injections of triptorelin 0,1 mg, one every other day starting from the day of embryo transfer, allowed to rescue the luteal phase in such cycles, avoiding the need of freezing all in most situations, and suggesting us the possibility that triptorelin effect may be beneficial itself for its effects on corpora lutea and endometrium [8].…”

“…Several ways to use a GnRH analogue have been proposed: triptorelin can be administered as a single bolus 1 week after the oocyte retrieval [6, 7], or 0,1 mg triptorelin can be given every other day from the day of embryo transfer for a total of five injections [8]. In alternative, a low dose of buserelin spray can be given daily for 2 weeks during the luteal phase [9–11].…”

Effect of mid-luteal phase GnRH agonist on frozen-thawed embryo transfers during natural menstrual cycles: a randomised clinical pilot study

“…Tesarik et al [10] were the first to report increased pregnancy rates after the midluteal administration of GnRHa in ovum donation. Since then, several reports using either single or repeated doses of GnRHa in IVF/ICSI have been published with conflicting results [11][12][13][14]. A few meta-analyses point to benefits of mid-luteal GnRHa in clinical pregnancy and LBR [2][3][4], but literature on mid-luteal GnRHa support in FETs is scarce [8,9].…”

Agonists gonadotropin-releasing hormone in post-transfer hormonal support of frozen-thawed embryo transfers (a review and experimental data)

“…Впервые данные об использовании аГнРГ в лютеиновой фазе циклов с использованием ооцитов донора опубликованы в 2004 г. Показано, что однократное введение реципиенту аГнРГ в день предположительной имплантации эмбриона донора достоверно повышало частоту наступления беременности и родов [4]. С тех пор опубликован ряд работ с противоречивыми результатами использования одной или повторных доз аГнРГ в протоколах ЭКО/ ИКСИ [14][15][16][17][18][19][20][21][22]. При этом большинство метаанализов указывают на преимущество применения аГнРГ в середине лютеиновой фазы.…”