Modified luteal support following GnRH-agonist trigger

Abstract

To demonstrate the use of modified luteal support following GnRh-agonist trigger in patients undergoing IVF/ICSI and at risk of Ovarian Hyper Stimulation Syndrome [OHSS] in preventing early OHSS without compromising pregnancy rate. This prospective, observational study was carried out on 49 patients undergoing IVF/ICSI and at risk of OHSS at Nova IVI Fertility, Ahmedabad from January 2012 to December 2012. The patients aged between 26 and 34 years [average 31 years], underwent stimulation from second day of period with 100 to 300IU of Gonadotropins[average 200IU] using the flexible antagonist protocol. GnRH agonist,[Triptorelin 0.2mg] was given to induce final oocyte maturation in patients at risk of developing OHSS[>20 follicles of >16 mm on the day of trigger].Average estradiol on the day of trigger was 5353+3983 pg/ml. Transvaginal oocyte retrieval[OR]was performed 35hours after the trigger. Luteal phase support was provided in form of vaginal progesterone tablets(200mg 3times/day) and oral estradiol valerate(2mg twice/day)from day after OR. Patients also received 1500 I.U. of recombinant hCG on day of ET. 2embryos were transferred on day3 after OR. An average 22.7+5.6 oocytes were retrieved,76% of which were at metaphaseII. Fertilization rate was 81% and 14+5 embryos were obtained. 2embryos were transferred on day3 in 42 patients and positive hCG rate was 30.9%[13/42] per ET. There was no early OHSS;one patient developed late onset pregnancy induced severe OHSS. Implantation rate was 19%[16/84], rates of miscarriage, ectopic and twins were 7.6%, 15.3%, 23% & ongoing pregnancy rate at 10 weeks was 23.8% [10/42]. GnRH agonists can be used effectively as an alternative to hCG trigger in patients at high risk of OHSS. This delayed administration of hCG provides luteal support& gives time to assess the number & grade of embryos & decide whether the patient should be given hCG & have an ET or should have elective cryopreservation of all embryos.