Abstract
Faiz Abdulwahid Alwaeely Basra Medical College, Almanar Fertility and Endoscopy Center Abstract The aim of this study is to compare clinical pregnancy rates in ICSI-ET cycles where GnRH agonist or hCG was used to induce final maturation of the oocytes. A total of 97 women who produced more than 14 follicles following ovulation induction with recombinant FSH and GnRH antagonist were selected for randomization. Human chorionic gonadotropin (hCG, 5.000 IU, IM) or GnRH agonist (triptorelin 0.2 mg, SC) was used for the induction of final maturation. Women in GnRH agonist group received higher dose of progesterone (100 mg vs. 50 mg) and estradiol (6 mg orally per day vs. none) compared to women in hCG group in the luteal phase starting on the day of oocyte pick-up. Age, duration of stimulation, dose of gonadotropins, peak estradiol levels were similar in both groups. The mean number of collected oocytes (14.7±2.1 vs. 13.8±4.3) and fertilization rates (70.7 ±18 vs.71.8 ±21) were not significantly different between women allocated to hCG group (n=53) and GnRH agonist group (n=44). Clinical pregnancy rates (37.7 vs. 36.3), miscarriage rates (15% vs. 18.7%) and ongoing pregnancy rates (32% vs. 29.5%) were similar between hCG group and GnRH agonist group, respectively. Two cases of moderate/severe OHSS occurred in the hCG group, and none in the GnRH agonist group. In conclusion, GnRH-agonist triggering together with high dose steroid supplementation in the luteal phase yields similar clinical pregnancy rate to that obtained with lower dose of hCG administration for final maturation. However, lower dose of hCG was associated with a higher incidence of moderate/severe OHSS.
Highlights
Ovulation induction using either Gonadotropin Releasing Hormone (GnRH) agonist or antagonist protocol has been used to achieve multifollicular development in IVF cycles
Moderate/ severe ovarian hyperstimulation syndrome (OHSS) developed in 2 women in the hCG group and none in the GnRH agonist group
The present prospective study has demonstrated that the use of GnRH agonist trigger together with a high dose steroid supplementation in the luteal phase does not impair clinical pregnancy rate and reduces moderate/severe OHSS rate in ICSI-ET cycles
Summary
Ovulation induction using either Gonadotropin Releasing Hormone (GnRH) agonist or antagonist protocol has been used to achieve multifollicular development in IVF cycles. GnRH agonist for inducing final oocyte maturation was used in many studies to reduce the risk of severe OHSS4-6. The reduced risk of OHSS without affecting implantation rate with the administration of adjusted doses of estradiol and progesteron supplementation in GnRH agonist triggering cycles has been reported[8]. Shapiro et al used aggresively enhanced steroid doses in the luteal phase and obtained similar pregancy rate with the dual trigger[9]. It is still not clear if using fixed increased doses of steroids in the luteal phase may restore an optimal endometrial environment. We compared the outcomes of ICSI-ET cycles where agonist was used for triggering combined with high dose steroidal supplementation with the low dose hCG for final maturation
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