Abstract
OBJECTIVE: The aim of the study is to compare the live birth rates between 1,500 I.U. of Human chorionic gonadotropin at the time of Gonadotropin-releasing hormone agonist trigger day or 35-36 h later on the oocyte pick-up day, without affecting the risk of significant ovarian hyperstimulation syndrome development in high-risk patients with peak E2 level <4,000 pg/mL STUDY DESIGN: This single-center prospective cohort study encompassed the period from March 2016 to March 2018 year. A total of 216 patients entered for final analysis, underwent a flexible antagonist protocol, intracytoplasmic sperm injection, and embryo transfer on the 3rd or 5th day in autologous cycles. Patients were randomized in one of two groups: Group A- Dual trigger group - 1,500 IU of Human chorionic gonadotropin at the time of Gonadotropin-releasing hormone agonist trigger day and Group B- 1,500 IU of Human chorionic gonadotropin 35-36 h later, on the oocyte pick-up day. To compare the two groups, we used nonparametric and parametric statistical tests. Significant differences were considered all values of p<0.05. RESULTS: There is no significant difference between the two (A vs B) groups according to the average number of retrieved oocytes (13.08 vs 14.41 p=0.08), M II oocytes (10.5 vs 10.95 p=0.46), GV (1.24 vs 1.52 p=0.09, the fertility rate (68.46% vs 64.04% p=0.07). The dual trigger group (A) had a significantly higher live birth rate (62.29% vs 42.37% p<0.05) compared with the Gonadotropin-releasing hormone-a trigger group (B). There were no cases of moderate or severe ovarian hyperstimulation syndrome in both groups. CONCLUSION: Our study shows that in hyper responders where the E2 peak is <4,000 pg/mL, the two approaches to the final oocyte maturation trigger have a correct outcome of the results, both in terms of the results from the in vitro fertilization and the low risk of ovarian hyperstimulation syndrome appearance.
Highlights
Оvarian hyperstimulation syndrome (OHSS) is a serious iatrogenic complication as a result of a response to gonadotropin and hCG application as a trigger
Our study shows that in hyper responders where the E2 peak is
Out of a total of 270 patients who passed the basic criteria for admission to the study and reached the trigger day criteria and randomization, 54 (20%) of the patients underwent the “freeze all protocol” due to the above criteria as estradiol higher than >4,000 pg/mL, (23/54; 42.59%) on the trigger day as the main criterion, more than 18 retrieved oocytes (18/54; 33.33%) in the group of estradiol
Summary
Оvarian hyperstimulation syndrome (OHSS) is a serious iatrogenic complication as a result of a response to gonadotropin and hCG application as a trigger. The introduction of the antagonist protocol with agonist (GnRH-a) as a trigger for oocyte maturation has dramatically reduced this incidence [3]. The advantage of this type of trigger (GnRH agonist) eliminates the risk for OHSS because of its short half-life in IVF cycles, but there is controversy regard-. Quick Response Code: Access this article online. Different Timing of Adjuvant Low Dose hCG and GnRH Agonist Trigger Protocol, in OHSS High-Risk Patient with Peak E2 Level
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