Gonadotropin Releasing Agonist for Triggering Final Oocyte Maturation Has Fewer Side Effects Than Recombinant hCG in Oocyte Donors

Abstract

To determine whether the use of a GnRH-a has fewer side effects than r-hCG in inducing final oocyte maturation. Retrospective cohort study. Academic medical center-based IVF practice. 258 cycles of oocyte donors (age 21 to 31) undergoing IVF between Jan 2007 and Dec 2009 were reviewed. Donors were pre-treated with OCP's and underwent standard GnRh antagonist protocol starting stimulation with FSH and Human Menopausal Gonadotropins (HMG) on day 2 off OCP's. GnRh antagonist was imitated as clinically indicated around cycle day 6. In order to induce final oocyte maturation, patients either received a GnRH-a trigger (Lupron 2 mg) (N=32) if deemed to be at high risk for OHSS, or r-hCG (ovidrel 250 mg) (N=226). A quantitative subjective pain and bloating questionnaire was completed by all donors. Mean ovarian size and degree of discomfort 5-8 days post retrieval were compared between both groups. Baseline characteristics and stimulation outcomes (oocytes retrieved and mature oocytes) for both groups were also collected. Data were analyzed using SPSS software [Table 1]. No significant differences were seen in IVF outcomes between the GnRh-a and r-hCG groups, other than significantly higher levels of peak estradiol and number of retrieved oocytes, consistent with the GnRH-a group being a high responder group. Despite this, patients in the GnRH-a trigger group had a lower mean ovarian size and were less likely to report bloating or pain 5 – 8 days post retrieval compared to those in the r-hCG group. As compared with r-HCG, the use of a GnRh-a was associated with fewer side effects when used to trigger final oocyte maturation. A significantly smaller mean ovarian size was also noted in the GnRH-a group.Table 1GnRH-a versus r-hCG GroupGnRH-a Trigger Group (N=32)r-hCG Trigger Group (N=226)BMI (kg/m2) (M SD)26.4±3.327.1±3.9Total gonadotropin dose(IU) (M SD)2122±8872412±967Peak E2 (pg/ml) (M SD)3536±11712402±891αDays of stimulation (M SD)10.1±1.610.0±1.7Oocytes retrieved (M SD)28.6±4.623.8±7.5 αPercent oocytes mature (%)83.2±3.285.1±7.3Mean right ovarian size 1 week post (mm) (M SD)39.6±10.651.3±11.4 βMean left ovarian size 1 week post (mm) (M SD)40.9±12.249.8±12.4 βBloating (Total N, %)29 (7%)104 (26%) γMild-moderate pain (%)21%45% αSevere OHSS0%0%α p<0.05, β p<0.001, γ p=0.05. Open table in a new tab