Abstract
This study is aimed at comparing clinical pregnancy rates (CPRs) in patients who are administered either gonadotropin-releasing hormone agonist (GnRHa) or human chorionic gonadotropin (hCG) for ovulation trigger in intrauterine insemination (IUI) cycles. A prospective randomized comparative study was conducted at Hue University Hospital in Vietnam. A total of 197 infertile women were randomly assigned to receive either GnRHa trigger (n = 98 cycles) or hCG trigger (n = 99 cycles) for ovulation trigger. Patients returned for ultrasound monitoring 24 hours after IUI to confirm ovulation. A clinical pregnancy was defined as the presence of gestational sac with fetal cardiac activity. There was no difference in ovulation rates in either group receiving GnRHa or hCG trigger for ovulation. Biochemical and CPR were higher in patients who received hCG (28.3% and 23.2%) versus GnRHa (14.3% and 13.3%) (p = 0.023, OR 0.42, 95%CI = 0.21 − 0.86 and p = 0.096, OR 0.51, 95%CI = 0.24 − 1.07, respectively). After adjusting for body mass index (BMI) and infertility duration, there was no difference in CPR between the two groups (OR 0.58, 95% CI 0.27-1.25, p = 0.163). In conclusion, the use of the GnRHa to trigger ovulation in patients undergoing ovulation induction may be considered in patients treated with IUI.
Highlights
Exogenous human chorionic gonadotropin is commonly used to achieve final oocyte maturation and trigger ovulation in patients undergoing ovulation induction
A significant increase in biochemical pregnancy rates (BPR) was found in natural intrauterine insemination (IUI) cycles triggered with human chorionic gonadotropin (hCG) versus gonadotropin-releasing hormone agonist (GnRHa) (29.6% vs. 14.1%, p = 0 031). hMG-stimulated cycles did not exhibit a difference in BPR triggered with GnRHa or hCG
BPR was increased in spontaneous cycles triggered with hCG vs. GnRHa (28.3% vs. 14.3%, p = 0 023)
Summary
Exogenous human chorionic gonadotropin (hCG) is commonly used to achieve final oocyte maturation and trigger ovulation in patients undergoing ovulation induction. It is widely accepted that the gonadotropin-releasing hormone agonist (GnRHa) can be used as an alternative with a comparative effect to hCG to achieve final oocyte maturation by inducing a LH and follicle-stimulating hormone (FSH) surge but decrease the risk of OHSS in in vitro fertilization (IVF) [2,3,4,5]. A potential benefit to employing the use of GnRHa trigger for IUI cycles may be to induce a more physiologic type of gonadotropin surge involving the flare effect of FSH and LH from the pituitary [5]. A study of IVF patients who were given a bolus of FSH in addition to the hCG trigger found better oocyte recovery and fertilization rates in comparison to hCG trigger alone [12]
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