Abstract
Final oocyte maturation is a crucial step in in vitro fertilization, traditionally achieved with a single bolus of human chorionic gonadotropin (hCG) given 36 hours before oocyte retrieval. This bolus exposes the patient to the risks of ovarian hyperstimulation syndrome (OHSS), particularly in the face of ovarian hyper-response to gonadotropins. Although multiple measures were developed to prevent OHSS, gonadotropin-releasing hormone (GnRH) agonist triggering is now globally recognized as the best approach to achieve this goal. The first report on the use of GnRH agonist as ovulation trigger in the context of OHSS prevention came from Rambam Health Care Campus, Haifa, Israel and appeared in 1988. This review details the events that culminated in worldwide acceptance of this measure and describes its benefit in the field of assisted reproductive technology.
Highlights
The first successful human in vitro fertilization (IVF) treatment was reported in 1978.1 It was achieved by harvesting an oocyte by laparoscopy in a natural cycle
At the same time, the combination of ovarian stimulation by gonadotropins after gonadotropinreleasing hormone (GnRH) agonist-induced pituitary downregulation and human chorionic gonadotropin (hCG) as final oocyte maturation trigger led to a sharp increase in the risk of ovarian hyperstimulation syndrome (OHSS)
Levels of inhibin A, pro-αC, estradiol, and progesterone were significantly lower from day 4 to day 14 after triggering final oocyte maturation by GnRH agonist compared with hCG
Summary
Special Issue on Gynecology, Fertility, and Obstetrics Guest Editors: Lior Lowenstein, M.D., M.S., M.H.A., Shahar Kol, M.D., and Zeev Weiner, M.D.
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