Towards an optimal luteal support modality in agonist triggered cycles: a randomized clinical trial

Elgindy, Eman; Sibai, Hoda; Mostafa, Mona; Gibreel, Ahmed; Darwish, Emad; Maghraby, Hassan

doi:10.1093/humrep/dey054

Cited by 16 publications

(8 citation statements)

References 28 publications

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“…Significantly lower implantation rates, CPR, and a higher rate of early pregnancy loss have been documented in antagonist IVF cycles triggered with GnRHa versus hCG despite luteal support with oral E 2 and vaginal progesterone [30]. A randomized controlled trial (RCT) did report similar ongoing pregnancy rates to hCG trigger when patients who were administered GnRHa trigger received low-dose hCG at the time of oocyte retrieval in addition to oral E 2 and intramuscular progesterone [31]. Therefore, our patients may not have received adequate luteal support as only 200 mg of progesterone was prescribed daily.…”

Section: Discussionmentioning

confidence: 99%

GnRH Agonist versus hCG Trigger in Ovulation Induction with Intrauterine Insemination: A Randomized Controlled Trial

Lê

Nguyen

Zolton

et al. 2019

International Journal of Endocrinology

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This study is aimed at comparing clinical pregnancy rates (CPRs) in patients who are administered either gonadotropin-releasing hormone agonist (GnRHa) or human chorionic gonadotropin (hCG) for ovulation trigger in intrauterine insemination (IUI) cycles. A prospective randomized comparative study was conducted at Hue University Hospital in Vietnam. A total of 197 infertile women were randomly assigned to receive either GnRHa trigger (n=98 cycles) or hCG trigger (n=99 cycles) for ovulation trigger. Patients returned for ultrasound monitoring 24 hours after IUI to confirm ovulation. A clinical pregnancy was defined as the presence of gestational sac with fetal cardiac activity. There was no difference in ovulation rates in either group receiving GnRHa or hCG trigger for ovulation. Biochemical and CPR were higher in patients who received hCG (28.3% and 23.2%) versus GnRHa (14.3% and 13.3%) (p=0.023, OR 0.42, 95%CI=0.21−0.86 and p=0.096, OR 0.51, 95%CI=0.24−1.07, respectively). After adjusting for body mass index (BMI) and infertility duration, there was no difference in CPR between the two groups (OR 0.58, 95% CI 0.27-1.25, p=0.163). In conclusion, the use of the GnRHa to trigger ovulation in patients undergoing ovulation induction may be considered in patients treated with IUI.

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Section: Discussionmentioning

confidence: 99%

GnRH Agonist versus hCG Trigger in Ovulation Induction with Intrauterine Insemination: A Randomized Controlled Trial

Lê

Nguyen

Zolton

et al. 2019

International Journal of Endocrinology

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“…Considering the advantages and disadvantages of LOD and IVM as described above, the currently used GnRH antagonist-based COS is more likely to be chosen as the first-line treatment for PCOS. However, this COS, which consists of using GnRH antagonist for suppression of spontaneous LH surge during gonadotrophin administration and GnRH agonist as a trigger, showed the best clinical outcome except for the occurrence of OHSS in about 10% of the cases [1][2][3][4][5] .…”

Section: Introductionmentioning

confidence: 98%

“…GnRH antagonist-agonist based COS, which is now widely used for PCOS, seems to be the best COS for PCOS even though it is accompanied with OHSS in up to 12% of all cases [1][2][3][4][5] . However, almost all of the studies on this topic reported the incidence of moderate to severe OHSS.…”

Section: Introductionmentioning

confidence: 99%

Combined use of Letrozole, Cabergoline and GnRH antagonist Eliminates Ovarian Hyperstimulation Syndrome (OHSS) in Polycystic Ovarian Syndrome (PCOS)

Yanagihara¹,

Tanaka²,

Nagayoshi³

et al. 2022

Evidence Based Women's Health Journal

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Aim: To determine if the properly timed, combined used of Letrozole, Cabergoline and GnRH antagonist eliminate the occurrence of ovarian hyper stimulation syndrome (OHSS) in polycystic ovarian syndrome (PCOS)? Study Design: We compared the severity of OHSS after using a new treatment with the severity of OHSS in a group of PCOS patients who received the GnRH antagonist-GnRH agonist-based controlled ovarian stimulation (COS) in retrospective cohort study between August 2019 and December 2021. Materials and Methods: 53 PCOS patients received the new treatment were compared to 32 PCOS patients treated with conventional methods. 5mg of Letrozole, 0.5mg of Cabergoline and 0.25mg of GnRH antagonist were administered from just after the oocyte pick up (OPU) for five consecutive days. Results: There were no significant differences in the clinical pregnancy rate, cumulative pregnancy rate and cumulative live birth rate between the two COS. The number of days between OPU and menstruation start in the novel COS was significantly lower than that of the conventional one (5.26+2.59 vs. 17.62+5.75). This treatment produced no incidences of OHSS, compared to 21.9% of all cases having mild OHSS with the conventional method. Conclusion:We found that administering Letrozole, Cabergoline and GnRH antagonist for five days consecutively after OPU effective for the complete prevention of OHSS.

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“…Of note, the rate of considerable OHSS in the agonist trigger group, although significantly lower than in the hCG trigger group, was surprisingly high (5%). It is likely that the exceptionally high rate of OHSS among IVF patients triggered with a GnRH agonist trigger in the study by Elgindy et al (16) stems from the addition of hCG on the day of OPU as well as from the fact that all these patients underwent embryo transfer and therefore fetal hCG may have contributed to the higher rates of late OHSS. In contrast, a small retrospective study by Safrai et al (17) reported similar OPR and LBR and no OHSS following MVP or oral dydrogesterone LPS in GnRH triggered cycles.…”

Section: Lps Following Gnrh Agonist Triggermentioning

confidence: 99%

Luteal phase support in fresh and frozen embryo transfers

Greenbaum

Athavale

Klement

et al. 2022

Front. Reprod. Health

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ContextLuteal phase support (LPS) has become an essential component of IVF protocols following both fresh and frozen embryo transfers, yet there is still controversy with regards to the optimal protocol of LPS to enhance treatment outcome.Search strategyA search via PubMed for all the selected topics was limited to publications from the past 10 years and to English language. We subsequently searched the reference lists of retrieved articles. Where available, RCTs were chosen over non-randomized studies. Here we provide an updated review of the current literature on various issues relating to LPS, in both fresh and frozen embryo transfers. The timing of LPS initiation as well as the route of administration and dosing are discussed for both fresh and frozen transfers. A separate discussion for frozen thawed embryo transfer in natural cycles and non-ovulatory cycles is presented.ConclusionsWe present data that supports the use of Progesterone LPS in fresh and frozen embryo transfers. No benefits were found to the addition of hCG or estradiol to progesterone LPS in fresh transfers, however GnRH agonist may have a role. IM Progesterone was not advantageous over vaginal progesterone in fresh transfers but was superior in frozen transfers. The timing of LPS introduction, the interval to embryo transfer, as well as the serum concentration of progesterone, have significant effects on the success of the treatment.

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Towards an optimal luteal support modality in agonist triggered cycles: a randomized clinical trial

Abstract: 26/6/2015.

Cited by 16 publications

References 28 publications

GnRH Agonist versus hCG Trigger in Ovulation Induction with Intrauterine Insemination: A Randomized Controlled Trial

GnRH Agonist versus hCG Trigger in Ovulation Induction with Intrauterine Insemination: A Randomized Controlled Trial

Combined use of Letrozole, Cabergoline and GnRH antagonist Eliminates Ovarian Hyperstimulation Syndrome (OHSS) in Polycystic Ovarian Syndrome (PCOS)

Luteal phase support in fresh and frozen embryo transfers

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