Abstract
ObjectiveTo evaluate pregnancy outcomes and the incidence of ovarian hyperstimulation syndrome (OHSS) using a sliding scale hCG protocol to trigger oocyte maturity and establish a threshold level of serum b-hCG associated with optimal oocyte maturity.DesignRetrospective cohort.SettingAcademic medical center.PatientsFresh IVF cycles from 9/2004–12/2011.Intervention10,427 fresh IVF-ICSI cycles met inclusion criteria. hCG was administered according to E2 level at trigger: 10,000IU vs. 5,000IU vs. 4,000IU vs. 3,300IU vs. dual trigger (2mg leuprolide acetate + 1,500IU hCG). Serum absorption of hCG was assessed according to dose and BMI.Main outcome measuresOocyte maturity was analyzed according to post-trigger serum b-hCG. Fertilization, clinical pregnancy, live birth and OHSS rates were examined by hCG trigger dose.ResultsPost-trigger serum b-hCG 20–30, 30–40, and 40–50 mIU/mL was associated with reduced oocyte maturity as compared b-hCG >50 (67.8% vs. 71.4% vs. 73.3% vs. 78.9%, respectively, P<0.05). b-hCG 20–50 mIU/mL was associated with a 40.1% reduction in live birth (OR 0.59, 95% CI 0.41–0.87). No differences in IVF outcomes per retrieval were seen for varying doses of hCG or dual trigger when controlling for patient age. The incidence of moderate to severe OHSS was 0.13% (n = 14) and severe OHSS was 0.03% (n = 4) of cycles.ConclusionsModerate stimulation with sliding scale hCG at trigger and fresh transfer is associated with low rates of OHSS and favorable pregnancy rates. Doses as low as 3,300IU alone or dual trigger with 1,500IU are sufficient to facilitate oocyte maturity.
Highlights
Major advances in the field of assisted reproductive technology (ART) have occurred over the past two decades
Post-trigger serum b-hCG 20–30, 30–40, and 40–50 mIU/mL was associated with reduced oocyte maturity as compared b-hCG >50 (67.8% vs. 71.4% vs. 73.3% vs. 78.9%, respectively, P
No differences in IVF outcomes per retrieval were seen for varying doses of hCG or dual trigger when controlling for patient age
Summary
Major advances in the field of assisted reproductive technology (ART) have occurred over the past two decades. The actual incidence varies based on published studies, but moderate OHSS has been cited to be as high as 3–10% of all ART cycle, and as high as 20% in high-risk populations [2,3]. Severe OHSS may carry perinatal morbidity with studies suggesting an increased risk of preterm delivery [5,6]. Several measures can be adopted to limit the occurrence of clinically relevant OHSS, including but not limited to lower the starting dose of gonadotropins, step down protocols, antagonist based stimulation protocols, coasting, GnRH agonist (GnRHa) triggers, and cryopreservation of embryos with subsequent freeze-thaw transfer [2,3,7,8,9,10]
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