Abstract
Objective To assess the efficacy of adding Gn-releasing hormone antagonist (GnRH-A) on the day of hCG triggering in a long luteal protocol without withholding the agonist in women who are at a risk to develop ovarian hyperstimulation syndrome (OHSS). Methods This was a retrospective cohort study conducted upon 50 women who have elevated serum estradiol (E 2 ) level >4 500 ng/L at the day of ovum triggering with hCG on a long agonist luteal protocol of controlled ovarian stimulation (COS). When an exaggerated ovarian response was observed around day 10 of stimulation, immediately the next morning at 6 a.m. gonadotropin administration was stopped or reduced, and a single dose of ganirelix acetate (antagonist) was given sc continuation of the agonist dose hCG. Another serum E 2 measurement was done at 6 p.m. (after 12 h of antagonist) then hCG, sc 250 mg and choriogonadotropin α were administered 14 h later after antagonist and documented the reduction of E 2 level. Oocyte retrieval was conducted after 34-36 h of hCG administration. The measured outcomes were the level of E 2 on the day of hCG injection, number of oocytes and their quality, pregnancy rate and the occurrence of OHSS and its grade in case it happened . Results The total dose for recombinant FSH was 25.3±6.4 ampoules (75 IU/ampoule) while it was 11.0±3.0 ampoules for the urinary hMG. A higher oocyte maturation rate (82.8%) and a high fertilization rate (87.8%) were observed. The mean endometrial thickness was 10.1±1.0 mm on the day of hCG triggering. The higher fertilization rate with the good endometrial thickness observed resulting in a higher pregnancy rate (78.0%, 39/50) with statistically significant (P 2 level was documented by a percentage around 40% before hCG injection. There were no reported cases of severe or moderate OHSS, however 13 cases (26%) were reported to have mild OHSS constituting. Conclusion Acceleration of coasting in cases of OHSS through treatment with GnRH-A after pituitary suppression with GnRH agonist (GnRH-a) offered a novel approach to decrease E 2 level, avoided cycle cancellation, and maintain excellent oocyte maturation rate, and finally result in high pregnancy rate with prevention of OHSS.
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