Withdrawal of GnRH agonist decreases oestradiol and VEGF concentrations in high responders

Abstract

This study evaluated whether the withdrawal of a gonadotrophin-releasing hormone (GnRH) agonist before triggering ovulation reduces the incidence of ovarian hyperstimulation syndrome (OHSS) in high-risk infertility patients who were treated with gonadotrophins. GnRH agonist was withdrawn for 2 or 3 days when dominant follicles were ≥14 mm in diameter, according to the GnRH agonist long protocol. Non-withdrawal of GnRH agonist was used as control. The serum concentration of oestradiol on the ovulation trigger day was significantly decreased in the GnRH agonist withdrawal group compared with the control group (5750.78 ± 2344.77 pg/ml versus 8076.43 ± 1981.67 pg/ml); however, the number of retrieved oocytes and the fertilization rate were similar between the groups. In addition, the concentrations of vascular endothelial growth factor in plasma on day of human chorionic gonadotrophin administration and follicular fluid on the oocyte retrieval day were decreased following GnRH agonist withdrawal. In fresh embryo transfer cycles, rates of clinical pregnancy, implantation and OHSS were not different between the groups. When GnRH agonist withdrawal was followed by total embryos cryopreserved, the rate of OHSS was decreased compared with the control group (0% versus 8.70%). Clinical pregnancy rates in cryopreserved embryo transfer cycles were comparable between the two groups.

The value of HCG serum concentrations after trigger in predicting pregnancy and live birth rates in IVF–ICSI

“…Baseline characteristics and outcomes for the whole group are presented in Table 1. In this group of young women, the clinical pregnancy rate was 74.2%, whereas the live birth rate was 68.4%, which were consistent with our previous studies (Ding et al, 2013;Zhou et al, 2012Zhou et al, , 2013.…”

“…All patients received standard ovarian stimulation with recombinent FSH under pituitary suppression with GnRH agonist according to a routinely used protocol (Ding et al, 2013). In all women, pituitary desensitization was achieved by subcutaneous administration of triptorelin (0.1 mg daily, which was reduced to 0.05 mg after ovarian arrest was confirmed) started in the mid-luteal phase of the previous cycle.…”

GnRH antagonist administered twice the day before hCG trigger combined with a step-down protocol may prevent OHSS in IVF/ICSI antagonist cycles at risk for OHSS without affecting the reproductive outcomes: a prospective randomized control trial

“…These findings are consistent with earlier reports where luteal phase GnRH antagonist administration in patients, stimulated with either an agonist or an antagonist protocol, with established severe early OHSS seems to lead to quick regression of OHSS and avoidance of patient hospitalization [18,35]. Ding et al [36] reported that the withdrawal of GnRH agonist alone for 2 or 3 days in the late follicular phase in hyperresponsive agonist cycles markedly decreased the expression of CYP19A1, the production of oestradiol and VEGF mRNA concentration in granulosa cells, confirming the direct ovarian effect of GnRH agonist. Therefore, someone can assume that the administration of GnRH antagonist in the late follicular phase may directly block GnRH receptors on granulosa cells leading to a similar and maybe more profound effect on oestradiol and VEGF concentrations, as discontinuation of GnRH agonist does.…”