Dual trigger of triptorelin and HCG optimizes clinical outcome for high ovarian responder in GnRH-antagonist protocols.

Saijiao Li,Tailang Yin,Wangming Xu,Dan Cheng,Jing Yang,Qingzhen Xie,Danni Zhou

doi:10.18632/oncotarget.23916

Saijiao Li, Tailang Yin + Show 5 more

Open Access

https://doi.org/10.18632/oncotarget.23916

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Journal: Oncotarget	Publication Date: Jan 4, 2018
Citations: 10	License type: cc-by

Affiliation: Renmin Hospital of Wuhan University

Abstract

In this paper, a retrospective cohort study was conducted to the high ovarian responders in GnRH-antagonist protocols of IVF/ICSI cycles. The purpose of the study is to investigate whether dual triggering of final oocyte maturation with a combination of gonadotropin-releasing hormone (GnRH) agonist and human chorionic gonadotropin (HCG) can improve the clinical outcome compared with traditional dose (10000IU) HCG trigger and low-dose (8000IU) HCG trigger for high ovarian responders in GnRH-antagonist in vitro fertilization/intracytoplasmic sperm injection (IVF-ICSI) cycles. Our study included 226 couples with high ovarian responders in GnRH-antagonist protocols of IVF/ICSI cycles. Standard dosage of HCG trigger (10000 IU of recombinant HCG) versus dual trigger (0.2 mg of triptorelin and 2000 IU of recombinant HCG) and low-dose HCG trigger (8000IU of recombinant HCG) were used for final oocyte maturation. Our main outcome measures were high quality embryo rate, the number of usable embryos, the risk of OHSS, duration of hospitalization and incidence rate of complications. Our evidence demonstrated that dual trigger is capable of preventing severe OHSS while still maintaining excellent high quality embryo rate in in high ovarian responders of GnRH-antagonist protocols.

Highlights

Over the past 2 decades, gonadotrophin-releasing hormone (GnRH) antagonist protocols has been proposed as a safer and efficacious way for ovarian stimulation [1]
The purpose of the study is to investigate whether dual triggering of final oocyte maturation with a combination of gonadotropin-releasing hormone (GnRH) agonist and human chorionic gonadotropin (HCG) can improve the clinical outcome compared with traditional dose (10000IU) HCG trigger and low-dose (8000IU) HCG trigger for high ovarian responders in GnRH-antagonist in vitro fertilization/intracytoplasmic sperm injection (IVF-ICSI) cycles
The three groups were compared for age, body mass index (BMI), infertility causes, duration of infertility, baseline follicle-stimulating hormone (FSH) and E2, duration of gonadotropin (Gn) stimulation, and Gn dose received by the patients

Summary

Introduction

Over the past 2 decades, gonadotrophin-releasing hormone (GnRH) antagonist protocols has been proposed as a safer and efficacious way for ovarian stimulation [1]. GnRH antagonists protocols have several advantages over the long agonist, including the rapid decrease luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels, without flare-up effect, a lower consumption of used gonadotropins, shorter overall treatment duration [2], especially for reducing the incidence of ovarian hyper-stimulation syndrome (OHSS) [3, 4]. Earlier studies have concluded that the use of a GnRH-a trigger has equal oocyte yield, maturity, fertilization, implantation, pregnancy compared to human chorionic gonadotropin (HCG) trigger in GnRH antagonist protocols [5]. Some studies have reported retrieval of more mature oocytes, optimize the pregnancy outcomes, and may reduce the incidence of immature oocyte syndrome for a sub-group of women, when triggered with GnRH-a compared with HCG [8,9,10]

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