GnRH-Agonist Trigger versus Human Chorionic Gonadotrophin (HCG) Trigger in Cases of Controlled Ovarian Stimulation; Randomized Controlled Trial

Mohamed Elmahdy,Suzan Elsharkawy

doi:10.4236/ojog.2021.1111135

Abstract

Objectives: The aim of the study was to compare the efficacy and safety of GnRH-agonist to the human chorionic gonadotrophin (HCG) trigger in cases of simple ovarian stimulation. Study design: Randomized controlled trial was conducted on 291 women complaining of unexplained infertility visiting Elshatby Maternity University Hospital from February to December 2019. Trial registration unique ID is PACTR202001787868341 (https://www.pactr.org/). Age included from 20 - 43 years. All patients were stimulated by the sequential stimulation protocol using letrozole then FSH injection, when the criteria of ovulation trigger were reached; cases were randomized into two groups using closed envelopes method. Group A (123 cases) GnRh agonist (triptorelin 0.2 IU) subcutaneous injection and Group B (168 cases) HCG 10,000 IU intramuscular injection were used for triggering of ovulation then followed by timed intercourse. Results: Primary outcome was the clinical pregnancy rate while rate of miscarriage and ovarian hyper-stimulation rate were the secondary outcome. Clinical pregnancy rates, in Group A were (21.1%) while it was (31.5%) in another group (P = 0.049). Miscarriage rate was (4.9%) in the first group and (3.6%) in the second group (P = 0.580). Except for one case of moderate ovarian hyper-stimulation syndrome (OHSS) complicated the HCG group, there were no such cases in GnRH group. Conclusion: Triggering final oocyte maturation with HCG was superior to GnRH agonists triggers as regards the clinical pregnancy rate.

Highlights

The first oocyte collected for successful in vitro fertilization was done by laparoscopy in a natural cycle without any stimulation [1]
Except for one case of moderate ovarian hyper-stimulation syndrome (OHSS) complicated the human chorionic gonadotrophin (HCG) group, there were no such cases in gonadotrobin-releasing hormone agonists (GnRH) group
The two studied groups were compared as regards the clinical pregnancy rates, abortion rates and ovarian hyperstimulation (OHSS) rates

Summary

Introduction

The first oocyte collected for successful in vitro fertilization was done by laparoscopy in a natural cycle without any stimulation [1]. The down regulation was first done by gonadotrobin-releasing hormone agonists (GnRH), added to the exogenous human chorionic gonadotropin (HCG) as a trigger for final oocyte maturation. Such a combination gave the best control of the cycle but carried the risk for a serious complication called ovarian hyper-stimulation syndrome (OHSS). To decrease the incidence of OHSS, and as a trial to avoid HCG triggering, the first report on using GnRh agonists as a trigger came from Rambam Health Care Campus in 1988 [4] They used agonists to induce an adequate luteinizing hormone (LH) surge in eight non-suppressed IVF cycles of high risk patients for OHSS [5]. The result appeared to decrease the clinical manifestations of the deadly syndrome, but the technique was not popular worldwide until the last decade of the twentieth century, after the production of GnRH antagonists with proven clinical activity and fewer side effects that can be used for pituitary down regulation instead of the agonists [6] [7], saving them for triggering in high risk patients

Objectives

Methods

Results

Discussion

Conclusion