Prediction, assessment, and management of suboptimal GnRH agonist trigger: a systematic review

Herman, Hadas Ganer; Horowitz, Eran; Mizrachi, Yossi; Farhi, Jacob; Raziel, Arieh; Weissman, Ariel

doi:10.1007/s10815-021-02359-y

Cited by 14 publications

(15 citation statements)

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“…Although the use of a dual trigger with both hCG and GnRHa was observed to increase the number of mature oocytes in poor, normal, and high responders, immature oocytes were still retrieved. 9,11 Most studies of oocyte maturation after COS have used a single trigger of hCG or GnRHa alone. These studies also did not focus on the effect of ovarian stimulation on the EMOP.…”

Section: Discussionmentioning

confidence: 99%

“…8 While most studies have focused on the total number of oocytes retrieved during COS, limited studies have investigated the EMOP during COS. The use of a dual trigger (hCG + GnRHa) for final oocyte maturation can increase the efficiency of mature oocyte production, 9 but immature oocytes are still inevitably retrieved. Therefore, this study aims to identify significant predictors for EMOP during dual-trigger COS using a GnRH antagonist protocol.…”

Section: Introductionmentioning

confidence: 99%

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Factors Associated with the Efficacy of Mature Oocyte Production after Dual-Trigger Controlled Ovarian Stimulation using A GnRH Antagonist Protocol

New,

Wu,

Chen

et al. 2023

Journal of the Chinese Medical Association

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Background: The number of mature oocytes retrieved plays a significant role in determining embryo development and pregnancy outcomes of in vitro fertilization (IVF). However, studies investigating factors predictive of the efficacy of mature oocyte production (EMOP) after dual-trigger controlled ovarian stimulation (COS) are rare. This study aims to identify key predictors of EMOP during dual-trigger COS with a gonadotropin-releasing hormone (GnRH) antagonist protocol for IVF. Methods: This retrospective cohort study included 359 first-time IVF patients undergoing dual-trigger COS with a GnRH antagonist protocol. EMOP was defined as the ratio of metaphase II (MII) oocyte count to antral follicle count (AFC). Based on EMOP results, patients were divided into two groups: group A (EMOP <70%; n = 232) and group B (EMOP ≥70%; n = 127). Results: Multivariate logistic regression analysis revealed that day-2 follicle-stimulating hormone (FSH), stimulation duration, and total oocyte count were the most significant predictors of EMOP (p < 0.05; odds ratios: 1.637, 3.400, and 1.530, respectively). Receiver operating characteristic analysis demonstrated that total oocyte count <9.5 (area under the curve [AUC], 0.782; sensitivity, 76.2%; specificity, 69.2%; p < 0.001) and stimulation duration <9.5 days (AUC, 0.725; sensitivity, 63.5%; specificity, 66.7%; p < 0.001) significantly predicted EMOP <70%. Stimulation duration combined with total oocyte count exhibited the highest power in predicting EMOP <70% (AUC, 0.767; sensitivity, 92.3%; specificity, 42.4%). Conclusion: Stimulation duration combined with total oocyte count was identified as the most important factor associated with the EMOP during dual-trigger COS in IVF using a GnRH antagonist protocol.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Factors Associated with the Efficacy of Mature Oocyte Production after Dual-Trigger Controlled Ovarian Stimulation using A GnRH Antagonist Protocol

New,

Wu,

Chen

et al. 2023

Journal of the Chinese Medical Association

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“…As mentioned, post-trigger suboptimal LH levels are correlated with an increased risk for EFS and a low oocyte retrieval rate. Various strategies supporting the luteal phase exogenously have been mplementated to achieve comparable pregnancy rates; however, some concerns for the effectiveness of GnRH-a to induce optimal response remain [ 5 ]. In this study, we tested whether hCG retrigger should be immediately used in when patients’ low LH detected after a GnRH-a single trigger.…”

Section: Discussionmentioning

confidence: 99%

“…Serum LH < 15 mIU/mL on the morning after trigger has been defined as suboptimal response to GnRH-a trigger and reported to be significantly associated with an increased risk of empty follicle syndrome (EFS) and dramatically decreased oocyte recovery [ 5 ]. Theoretically, patients with poor post-trigger LH response, such as in the case of oocyte aspiration failure, hCG retrigger should be considered as an alternative regimen [ 5 ]. Another study suggested that LH levels measured at 12 h after trigger were not statistically significant with maturation rates and EFS was not reported [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Low LH level does not indicate poor IVF cycle outcomes with GnRh-a single trigger: a retrospective analysis

Li¹,

Wang

He³

et al. 2022

BMC Pregnancy Childbirth

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Objective To compare the in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycle outcomes between patients with low and normal serum luteinizing hormone (LH) levels on the day after a gonadotropin-releasing hormone agonist (GnRH-a) single trigger. We further investigated the efficacy of human chorionic gonadotropin (hCG) retrigger on IVF cycle outcomes in patients with low LH levels after GnRH-a single trigger. Methods We retrospectively analyzed 957 infertile patients (tubal factor, ovulation disorders, male sperm factor, or unexplained infertility) who were treated with IVF/ICSI at the Chengdu Xinan Gynecology Hospital from July 2017 to December 2020. Patients received sufficient GnRH-a single trigger were divided into two groups based on the serum LH levels on the next day of trigger: normal serum LH levels (≥ 10 mIU/mL) group (control group, n = 906) and low LH levels (< 10 mIU/mL) group (experimental group, n = 51). And the efficacy of hCG retrigger on IVF/ICSI cycle outcomes in 10 patients with low LH levels after GnRH-a single trigger. Results There were no significant differences in IVF/ICSI cycle outcomes, including egg yield, two pronuclei fertilization rate, excellent embryo rate, or live birth rate of frozen-thawed embryos between patients with low and normal LH levels after GnRH-a trigger. It showed significantly higher risk of ovarian hyperstimulation syndrome in the group of low LH levels [ 0.7%(1/137) vs. 8.5%(4/47), P = 0.016] compared with the group of normal LH levels who received GnRH-a single trigger. The hCG retrigger had no obvious efficacy on cycle outcomes in patients with low LH levels, including oocytes retrieved, fertilization rate, embryo conditions, and live birth rate of frozen-thawed cycles. Conclusion The IVF/ICSI cycle outcomes of patients with low LH levels on the day after GnRH-a administration were similar to those of patients with normal LH levels. Blood LH test might not be required on the day following the trigger. The hCG retrigger did not have any effect on the cycle outcomes, suggesting that immediate retriggering with hCG was unnecessary.

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“…Albeit covering studies with low quality evidence, a recent review pointed out that the effectiveness of a GnRHa trigger does not vary according to the OS employed, whereas a suboptimal LH surge is associated with decreased basal and trigger day serum LH levels and prolonged OS or oral contraceptive use [12].…”

Section: Generalmentioning

confidence: 99%

Progestin-primed ovarian stimulation

Giles,

Cruz,

Garcia-Velasco

2024

Current Opinion in Obstetrics &Amp; Gynecology

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Purpose of review The use of progestins as pituitary suppressors has increased progressively, along with more detailed indications for their use, thereby consolidating an alternative approach to the personalization of ovarian stimulation. Recent findings Based on the ability of progesterone to inhibit ovulation, progestins have been used in ovarian stimulation (OS) follicular protocols to prevent a luteinizing hormone surge in patients undergoing in vitro fertilization (IVF), as an alternative to gonadotropin-releasing hormone (GnRH) analogue administration. This review explores the different types of progestogen protocols and their efficacy depending on the type of population or reproductive procedure in which they are administered and in comparison with that of GnRH analogues. Their effect on oocytes and embryos and their safety and cost-effectiveness are also analyzed. Summary Progestins have proven their effectiveness as a gonadotropin adjuvant in terms of ovarian response, reproductive outcome, and safety. In addition, they offer the convenience of oral administration and a lower cost than GnRH analogues. Whereas oocytes or embryos should be vitrified as it displaces the receptive period with the consequent asynchrony between embryo and endometrium. The evidence endorses progestins as a more friendly approach to OS, especially when frozen-thawed embryo transfer is planned.

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Prediction, assessment, and management of suboptimal GnRH agonist trigger: a systematic review

Cited by 14 publications

References 50 publications

Factors Associated with the Efficacy of Mature Oocyte Production after Dual-Trigger Controlled Ovarian Stimulation using A GnRH Antagonist Protocol

Factors Associated with the Efficacy of Mature Oocyte Production after Dual-Trigger Controlled Ovarian Stimulation using A GnRH Antagonist Protocol

Low LH level does not indicate poor IVF cycle outcomes with GnRh-a single trigger: a retrospective analysis

Progestin-primed ovarian stimulation

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