Triggering of final oocyte maturation with gonadotropin-releasing hormone agonist or human chorionic gonadotropin. Live birth after frozen-thawed embryo replacement cycles

Purpose To analyze the cycle outcomes and the incidence of ovarian hyperstimulation syndrome (OHSS), when oocyte maturation was triggered by gonadotropin-releasing hormone agonist (GnRHa) versus human chorionic gonadotropin (hCG) in breast cancer patients undergoing fertility preservation. Methods One hundred twenty-nine women aged≤45 years, diagnosed with stage≤3 breast cancer, with normal ovarian reserve who desired fertility preservation were included in the retrospective cohort study. Ovarian stimulation was achieved utilizing letrozole and gonadotropins. Oocyte maturation was triggered with GnRHa or hCG. Baseline AMH levels, number of oocytes, maturation and fertilization rates, number of embryos, and the incidence of OHSS was recorded. Results The serum AMH levels were similar between GnRHa and hCG groups (2.7±1.9 vs. 2.1±1.8; p=0.327). There was one case of mild or moderate OHSS in the GnRHa group compared to 12 in the hCG group (2.1 % vs. 14.4 %, p=0.032). The maturation and fertilization rates, and the number of cryopreserved embryos were significantly higher in the GnRHa group.Conclusions GnRHa trigger improved cycle outcomes as evidenced by the number of mature oocytes and cryopreserved embryos, while significantly reducing the risk of OHSS in breast cancer patients undergoing fertility preservation.

Section: Discussionmentioning

confidence: 71%

Triggering final oocyte maturation with gonadotropin-releasing hormone agonist (GnRHa) versus human chorionic gonadotropin (hCG) in breast cancer patients undergoing fertility preservation: an extended experience

Reddy

Turan

Bedoschi

et al. 2014

“…Therefore, exogenous gonadotropin is needed to replace the endogenous LH surge. The most commonly used exogenous LH is human chorionic gonadotropin (hCG), which simulates the physiologic effects of LH, and is used to trigger the final follicular maturation before oocyte retrieval in ART program [1]. The interval between hCG priming and oocyte retrieval is very important, because a series of crucial processes, such as the start of luteinization, expansion of cumulus cells, and the resumption of oocyte meiosis are accomplished in the interval [2].…”

Section: Introductionmentioning

confidence: 99%

The time interval between hCG priming and oocyte retrieval in ART program: a meta-analysis

Wang

Zhang

Wang

et al. 2011

Objective To evaluate the relationship between different hCG priming-to-oocyte retrieval intervals and assisted reproductive technology (ART) outcome. Methods We systematically searched PubMed, EMBASE, the Cochrane Library, Science Citation Index, Chinese biomedicine (CBM) literature database, and Chinese Journal Full-text Database for randomized controlled trials (RCTs) published up to November 2010. Data was extracted from the studies by two independent reviewers. Statistical analysis was performed with Cochrane Collaboration's Review Manager (RevMan) 5.0.2. From extracted data, Risk Ratio (RR) with 95% confidence interval (CI) was calculated. Results 5 RCTs totaling 895 participants were included. Oocyte maturation rate was higher in the long interval group compared with short interval group (RR, 0.67; 95% CI, 0.62-0.73). There were no significant difference between the two groups with regard to fertilization rate (RR, 0.99; 95% CI, 0.94-1.04), implantation rate (RR, 0.91; 95% CI, 0.40-2.04), and pregnancy rate (RR, 0.79; 95% CI, 0.58-1.08). Conclusion The percentage of mature (MII) oocytes can be increased by prolonging the interval between hCG priming and oocyte retrieval. The prolonged interval could not increase the fertilization rate, implantation rate, and pregnancy rate. Although there was evidence to confirm the results, they still need to be confirmed by large-sample, multicenter, randomized controlled trials. The time interval dependent mechanisms responsible for ART performance need to be elucidated.

“…However, the likelihood of an ongoing clinical pregnancy and implantation was significantly lower after GnRH agonist triggering compared with the standard hCG treatment [4,5]. Agonist triggering has also been tested in frozen-embryo replacement IVF cycles; these studies found that the likelihood of a live birth after GnRH triggering of final oocyte maturation was not impaired, suggesting that the impaired clinical pregnancy and implantation rates in IVF cycles may be due to endometrial factors in antagonist cycles triggered for oocyte maturation with GnRH agonists [6]. Since ovarian stimulation in donor egg cycles may increase the risk of OHSS, triggering with agonist vs. hCG was also compared in oocyte donation cycles.…”

Section: Introductionmentioning

confidence: 99%

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

Şişmanoğlu¹,

Tekin²,

Erden³

et al. 2009

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.