Abstract
Research question: Urine LH testing may be useful to confirm an LH surge after the GnRH agonist (GnRHa) trigger prior to oocyte retrieval in IVF.Design: A prospective cohort study, including oocyte donors undergoing ovarian stimulation, treated with a GnRHa trigger for final oocyte maturation. Urine LH testing was performed at home, 12 h after the GnRHa trigger. In the case of a negative result, serum LH and progesterone measurements were done that same day. Donors with no serum LH peak after trigger were re-scheduled using a dual trigger, with GnRHa and hCG.Results: Three hundred and fifty nine oocyte donors were included in the analysis. Three hundred and fifty six donors had positive urine LH tests, followed by oocyte retrieval. In one case, the LH test was positive, however, no oocytes were retrieved (false positive 1/356). Three LH tests were negative in urine: in one of these three cases, LH was tested again in blood, confirming an LH rise, consistent with an optimal response to the GnRHa trigger; in the other two cases, serum LH was <15 mUI/mL, after which the oocyte retrieval was re-scheduled for 36 h after an being re-triggered, resulting in the retrieval of 19 and 22 MII oocytes, respectively. Considering the cost analysis, it would be a significantly cost-saving strategy, as blood testing would have costed 14,840€ vs. only 185.5€ in urine LH kits.Conclusions: Urinary testing of the LH surge after GnRHa trigger is easy, safe, reliable, and convenient. In addition, LH urine testing allows identifying donors and patients who could benefit from a rescue hCG trigger after an unsuccessful GnRHa trigger.
Highlights
In clinical practice, the total number of oocytes retrieved usually differs from the number of mature follicles observed on ultrasound as not all growing follicles will generate mature oocytes
Empty Follicle Syndrome (EFS) is defined as a sporadic event in patients with adequate ovarian stimulation and final oocyte maturation trigger, correctly administered [4]
The present study aimed to explore whether the routine use of urine LH testing in oocyte donors 12 h after GnRHa trigger for final oocyte maturation would correctly detect an insufficient LH surge
Summary
The total number of oocytes retrieved usually differs from the number of mature follicles observed on ultrasound as not all growing follicles will generate mature oocytes. It is not uncommon in IVF not to retrieve the same number of oocytes as mature follicles observed on ultrasound. In the case of a GnRHa trigger, failure to retrieve mature oocytes should not always be classified as an Empty Follicle Syndrome (EFS) [3], as the pathophysiology is likely to be different. EFS is defined as a sporadic event in patients with adequate ovarian stimulation and final oocyte maturation trigger, correctly administered [4]. Even though failure to retrieve oocytes after GnRH agonist triggering is relatively uncommon, there is a need to prevent the occurrence –a frustrating experience for both patients and physicians
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