A novel oocyte maturation trigger using 1500IU of human chorionic gonadotropin plus 450IU of follicle-stimulating hormone may decrease ovarian hyperstimulation syndrome across all in vitro fertilization stimulation protocols.

Abstract

Modification of the trigger used to induce final oocyte maturation in in vitro fertilization (IVF) is a major strategy used to reduce the risk of ovarian hyperstimulation syndrome (OHSS). A novel trigger composed of 1500IU of human chorionic gonadotropin (hCG) plus 450IU of follicle-stimulating hormone (FSH) has been developed to reduce OHSS risk. This study compares outcomes of the novel trigger to conventional triggers used in high-risk OHSS patients undergoing IVF. In this retrospective cohort study, IVF cycles at high risk for OHSS based on a serum estradiol >5000pg/ml on trigger day conducted between January 2008 and February 2016 were evaluated. Oocyte maturation was induced with the novel trigger (1500IU hCG plus 450IU FSH) or a conventional trigger [3300IU hCG, gonadotropin-releasing hormone agonist (GnRHa) alone, or GnRHa plus 1500IU hCG]. IVF cycle outcomes were compared. Trigger strategies were examined for associations with OHSS development using logistic regression. Among 298 eligible IVF cycles identified, there were no differences in oocyte maturation, fertilization, embryo quality, or pregnancy outcomes among all triggers. After adjusting for serum estradiol level and number of follicles, the novel trigger was associated with lower odds of OHSS symptom development compared to the 3300IU hCG and GnRHa plus hCG 1500IU triggers (p=0.007 and 0.04, respectively). This study suggests that 1500IU hCG plus 450IU FSH may be associated with decreased OHSS symptoms compared to conventional triggers, while producing similar IVF and pregnancy outcomes. More important, this novel trigger may provide a superior alternative in down-regulated cycles and in patients with hypothalamic dysfunction where GnRHa triggers cannot be utilized.