Ovulation triggering with GnRH agonist vs. hCG in the same egg donor population undergoing donor oocyte cycles with GnRH antagonist: a prospective randomized cross-over trial

Abstract

Objective To compare fertilization, implantation and pregnancy rates in donor oocyte cycles triggered for final oocyte maturation with either human chorionic gonadotropin (hCG) or gonadotropin releasing hormone (GnRH) agonist in the same donor population in two sequential stimulation cycles. Design Prospective randomized cross-over trial. Setting Private infertility clinic. Patient(s) Eighty-eight stimulation cycles in 44 egg donors. Interventions Controlled ovarian hyperstimulation (COH) with GnRH antagonist protocol triggered with hCG or GnRH agonist (leuprolide acetate 0.15 mg) in the same egg donors in two consecutive cycles. Main outcome measure(s) The primary outcome measure was the proportion of mature and fertilized oocytes per donor cycle. Secondary outcome measures were implantation and pregnancy rates in the recipients and incidence of ovarian hyperstimulation syndrome (OHSS) in oocyte donors. Result(s)The proportion of mature oocytes, fertilized oocytes and mean embryo scores were comparable between the two triggering agents. While implantation (36.53% vs, 32.93%), pregnancy (69.08% vs. 68.81%) and clinical pregnancy (41.3% vs. 40.2%) rates were comparable for the groups, the incidence of OHSS was significantly lower in GnRH than in hCG triggered cycles. Conclusion(s) Fertilization, implantation and pregnancy rates from donor oocytes stimulated with GnRH antagonist protocol were identical for donor cycles triggered with hCG and GnRH agonist. GnRH antagonist triggering in egg donors was associated with lower rates of OHSS.

Factors that predict the probability of a successful clinical outcome after induction of oocyte maturation with a gonadotropin-releasing hormone agonist

“…Several studies have shown that induction of oocyte maturation using a GnRH agonist instead of hCG is effective in the prevention of OHSS during IVF cycles (1,11,14) as well as in oocyte donors (3,15,16). However, the use of this protocol in the prevention of OHSS during IVF cycles has not gained widespread acceptance in view of concerns regarding its potential adverse effect on pregnancy rates (5,6).…”

“…The high pregnancy rates that have been described in recipients of oocytes from patients triggered with a GnRH agonist (3,(15)(16)(17) as well as in patients receiving frozen embryos from fresh cycles triggered with a GnRH agonist (18,19) argue against an adverse effect on oocyte or embryo quality. It is therefore logical that an effect on endometrial receptivity may be a tangible explanation.…”

Late ovarian hyperstimulation syndrome after controlled ovarian stimulation in a woman with systemic lupus erythematosus and lupus nephritis

“…Two separate studies, one a large retrospective cohort study and the other a prospective randomized crossover trial of 88 women, compared a GnRH agonist with a hCG trigger in oocyte donors. There were no cases of OHSS after the GnRH-agonist trigger in either study (33,34). In all three studies, no statistically significant difference in fertilization, implantation, or pregnancy rates was noted (32)(33)(34).…”

“…There were no cases of OHSS after the GnRH-agonist trigger in either study (33,34). In all three studies, no statistically significant difference in fertilization, implantation, or pregnancy rates was noted (32)(33)(34). Because the shorter half-life of the endogenous LH surge and resultant pituitary suppression may lead to early luteolysis, it is important to monitor E 2 and progesterone levels and provide adequate luteal phase support in patients not transferring into a surrogate (3,32).…”

Recent Advances in Assisted Reproductive Technology

“…In several trials, utilization of such protocols that utilize lower doses of injectable gonadotropins results in comparable pregnancy rates with decreased medical complications and cost compared with more standard COH protocols [9•, 12]. Another recent strategy for minimizing the risk of OHSS in COH cycles is the use of gonadotropin releasing hormone (GnRH) agonist, instead of human chorionic gonadotropin (hCG), to trigger ovulation during an IVF cycle [13]. Taken together, minimal stimulation COH protocols and the appropriate utilization of GnRH agonist to trigger ovulation have the potential to mitigate the incidence of IVF associated OHSS, significantly improving the safety of women undergoing ART.…”