Effect of low dose hCG support on GnRH-agonist triggered IVF/ICSI cycles

Abstract

To assess the reproductive outcome (pregnancy rate and OHSS rate) in high responders after triggering final oocyte maturation with a combination of GnRH-agonist and hCG (500 to 1,000 IU) as compared with those triggered with GnRH-agonist alone and those treated with long protocol. Controlled interventional study. In high responders, three groups of ovulation induction cycles were allocated as below: (30 cycles for each group) 1. GnRH-antagonist protocol, triggered with a combination of GnRH-agonist and hCG (500 to 1,000 IU, depending on the peak Estradiol level) for final oocyte maturation 2. GnRH-antagonist protocol, triggered with GnRH-agonist alone for final oocyte maturation. 3. Long protocol (triggered with 10,000 IU hCG for final oocyte maturation) The clinical pregnancy rate and the rate of ovarian hyperstimulation syndrome (OHSS) were compared among the three groups. No significant differences were seen regarding positive hCG/ET rate, clinical pregnancy rate, and rate of early pregnancy loss between group 1 (GnRH-agonist and hCG dual trigger) and group 3 (long protocol). A tendency of lower pregnancy rate was noted in group 2 (GnRH-agonist trigger alone). There was no OHSS in group 1 (GnRH-agonist and hCG dual trigger) and group 2 (GnRH-agonist trigger alone). For higher responders, dual trigger with a combination of GnRH-agonist and hCG is safe considering the complication of OHSS, and as effective as conventional long protocol regarding the pregnancy outcome.