hCG Trigger Research Articles

In vitro fertilization outcome based on the detailed early luteal phase trajectory of hormones: a prospective cohort study

BackgroundOvarian stimulation and the use of human chorionic gonadotropin (hCG) for triggering oocyte maturation in women undergoing in vitro fertilisation (IVF) introduces several differences in luteal phase hormone levels compared with natural cycles that may negatively impact on endometrial receptivity and pregnancy rates after fresh embryo transfer. Exogenous luteal phase support is given to overcome these issues. The suitability of a pragmatic approach to luteal phase support is not known due to a lack of data on early phase luteal hormone levels and their association with fertility outcomes during IVF with fresh embryo transfer. This study determined early luteal phase profiles of serum progesterone, 17-hydroxyprogesterone and hCG, and associations between hormone levels/hormone level profile after hCG trigger and the live birth rate in women undergoing IVF with fresh embryo transfer.MethodsThis prospective single center, cohort study was conducted in Vietnam from January 2021 to December 2022. Women aged 18–38 years with normal ovarian reserve and undergoing controlled ovarian stimulation using a gonadotropin-releasing hormone antagonist protocol were included. Serum hormone levels were determined before trigger, at 12, 24 and 36 h after hCG, and daily from 1 to 6 days after oocyte pick-up. Serum hormone level profiles were classified as lower or upper. The primary outcome was live birth rate based on early luteal phase hormone level profile.ResultsNinety-five women were enrolled. Live birth occurred in 19/69 women (27.5%) with a lower progesterone profile and 13/22 (59.1%) with an upper progesterone profile (risk ratio [RR] 2.15; 95% confidence interval [CI] 1.28–3.60), and in 6/31 (19.4%) versus 26/60 (43.3%) with a lower versus upper serum 17-hydroxyprogesterone profile (RR 2.24; 95% CI 1.03–4.86). Nearly 20% of women had peak progesterone concentration on or before day 3 after oocyte pick-up, and this was associated with significantly lower chances of having a life birth.ConclusionsThese data show the importance of proper corpus luteum function with sufficient progesterone/17-hydroxyprogesterone production for achievement of pregnancy and to maximize the chance of live birth during IVF.Trial RegistrationNCT04693624 (www.clinicaltrials.gov).

Dual FSH and HCG Triggering Increases Clinical Pregnancy Rate in IUI for Unexplained Infertility: A Randomized Controlled Trial

Dual FSH and HCG Triggering Increases Clinical Pregnancy Rate in IUI for Unexplained Infertility: A Randomized Controlled Trial

Reproductive outcomes of dual trigger therapy with GnRH agonist and hCG versus hCG trigger in women with diminished ovarian reserve: a retrospective study

BackgroundDiminished ovarian reserve (DOR) is one of the obstacles affecting the reproductive outcomes of patients receiving assisted reproductive therapy. The purpose of this study was to investigate whether dual trigger, including gonadotropin‐releasing hormone agonist (GnRHa) and human chorionic gonadotropin (hCG), can improve pregnancy outcomes in patients with DOR undergoing in vitro fertilization (IVF) cycles using mild stimulation protocols.MethodsA total of 734 patients with DOR were included in this retrospective study. Patients were divided into a recombinant hCG trigger group and a dual trigger group (hCG combined with GnRHa) according to the different trigger drugs used. The main outcome measures included the number of oocytes retrieved, the fertilization rate, the number of transferable embryos, the implantation rate, the clinical pregnancy rate, the miscarriage rate, the live birth rate (LBR), and the cumulative live birth rate (CLBR). Generalized linear model and logistic regression analyses were performed for confounding factors.ResultsThere were 337 cycles with a single hCG trigger and 397 cycles with dual trigger. The dual trigger group demonstrated significantly higher numbers of retrieved oocytes [3.60 vs. 2.39, adjusted β = 0.538 (0.221–0.855)], fertilized oocytes [2.55 vs. 1.94, adjusted β = 0.277 (0.031–0.523)] and transferable embryos [1.22 vs. 0.95, adjusted β = 0.162 (-0.005–0.329)] than did the hCG trigger group, whereas no significant difference in the fertilization rate was observed between the two groups. Moreover, the embryo transfer cancellation rate (35.5% vs. 43.9%) was obviously lower in the dual trigger group. Among the fresh embryo transfer cycles, the implantation rate, clinical pregnancy rate, miscarriage rate and live birth rate were similar between the two groups. After controlling for potential confounding variables, the trigger method was identified as an independent factor affecting the number of oocytes retrieved but had no significant impact on the CLBR.ConclusionsDual triggering of final oocyte maturation with hCG combined with GnRHa can significantly increase the number of oocytes retrieved in patients with DOR but has no improvement effect on the implantation rate, clinical pregnancy rate or LBR of fresh cycles or on the CLBR.

Effect of follicle size on pregnancy outcomes in patients undergoing first letrozole-intrauterine insemination.

Letrozole has been proven to be an effective method for inducing ovulation. However, littleattentionhasbeenpaidto whether the lead follicle size will affect the success rate of intrauterine insemination (IUI) with ovulation induction with alone letrozole. Therefore, we hope to investigate the effect of dominant follicle size on pregnancy outcomes on human chorionic gonadotropin (hCG) day of the first letrozole-IUI. A retrospective cohort study design was employed. We included patients with anovulation or unexplained infertility undergoing first IUI treatment with letrozole for ovarian stimulation. According to the dominantfolliclesize measured on the day of hCG trigger, patients were divided into six groups (≤ 18mm, 18.1-19.0mm, 19.1-20.0mm, 20.1-21.0mm, 21.1-22.0mm, > 22mm). Logistic models were used for estimating the odds ratios (ORs) with their 95% confidence interval (CIs) for achieving aclinicalpregnancyor alivebirth. A restricted cubic spline was drawn to explore the nonlinear relationship between follicle size and IUI outcomes. A total of 763 patients underwent first letrozole-IUI cycles in our study. Fisherexact test showed significant differences among the six follicle-size groups in the rates of pregnancy, clinical pregnancy and live birth (P < 0.05 in each group). After adjusting the potential confounding factors, compared with the follicles ≤ 18mm in diameter group, 19.1-20.0mm, 20.1-21.0mm groups were 2.3 or 2.56 times more likely to get live birth [adjusted OR = 2.34, 95%CI (1.25-4.39); adjusted OR = 2.56, 95% CI (1.30-5.06)]. A restricted cubic spline showed an invertedU-shaped relationship between the size of dominant follicles and pregnancy rate, clinical pregnancy rate, and live birth rate, and the optimal follicle size range on the day of hCG trigger was 19.1-21.0mm. When the E2 level on the day of hCG trigger was low than 200pg/mL, the clinical pregnancy rates of 19.1-20.0mm, 20.1-21.0mm groups were still the highest. The optimal dominant follicle size was between 19.1 and 21.0mm in hCG-triggered letrozole-IUI cycles. Either too large or too small follicles may lead to a decrease in pregnancy rate. Using follicle size as a predicator of pregnancy outcomes is more meaningful when estrogen on the day of hCG trigger is less than 200pg/ml.

Contributing factors for pregnancy outcomes in women with PCOS after their first FET treatment: a retrospective cohort study

Objective We aim to explore the contributing factors of clinical pregnancy outcomes in PCOS patients undergoing their first FET treatment. Methods A retrospective analysis was conducted on 574 PCOS patients undergoing their first FET treatment at a private fertility center from January 2018 to December 2021. Results During the first FET cycle of PCOS patients, progesterone levels (aOR 0.109, 95% CI 0.018-0.670) and endometrial thickness (EMT) (aOR 1.126, 95% CI 1.043-1.419) on the hCG trigger day were associated with the clinical pregnancy rate. Similarly, progesterone levels (aOR 0.055, 95% CI 0.007-0.420) and EMT (aOR 1.179, 95% CI 1.011-1.376) on the hCG trigger day were associated with the live birth rate. In addition, AFC (aOR 1.179, 95% CI 1.011-1.376) was found to be a risk factor for preterm delivery. Conclusions In women with PCOS undergoing their first FET, lower progesterone levels and higher EMT on hCG trigger day were associated with clinical pregnancy and live birth, and AFC was a risk factor for preterm delivery. During FET treatment, paying attention to the patient’s endocrine indicators and follicle status may have a positive effect on predicting and improving the pregnancy outcome of PCOS patients.

Evaluation of Dual Trigger versus Higher Dose hcg trigger in antagonist protocol for patients with low number of oocytes retrieved per number of follicles

Evaluation of Dual Trigger versus Higher Dose hcg trigger in antagonist protocol for patients with low number of oocytes retrieved per number of follicles

Reproductive Outcomes of Dual Trigger versus hCG Alone in Women Undergoing In Vitro Fertilization with Fresh Embryo Transfer Cycles.

To investigate the effect of the triggering method on the results of fresh embryo transfer in patients who underwent gonadotropin-releasing hormone antagonist cycles. The study was conducted retrospectively at a university-based tertiary reproductive center. The sample consisted of a total of 295 patients, of whom 111 were in the human chorionic gonadotropin (hCG) trigger group and 184 were in the dual trigger group. The main outcome measure of this study was the live birth rate, and secondary outcomes were the implantation rate, clinical pregnancy rate, miscarriage rate, and good-quality embryo rate. Patient demographics and baseline characteristics did not significantly differ between the dual and hCG trigger groups. The results also indicated statistically nonsignificant differences between the two groups in terms of the number of oocytes retrieved (p > 0.05), the number of mature oocytes (p > 0.05), and the fertilization rate (p > 0.05). The number of good-quality embryos (p=0.002) was higher in the dual trigger group compared with the hCG trigger group. However, the rates of clinical pregnancy and live births did not significantly differ between the groups (p > 0.05). Although the number of total and high-quality embryos obtained was higher in the dual trigger group, there were no significant differences between the two groups in terms of pregnancy outcomes. The fresh embryo transfer yielded similar rates of implantation and live births in both trigger groups.

The comparison between fixed versus degressive doses of medroxyprogesterone acetate combined with letrozole in patients of progestin-primed ovarian stimulation protocol: a propensity score-matched study.

To explore the cycle characteristics and pregnancy outcomes of progestin-primed ovarian stimulation (PPOS) using fixed versus degressive doses of medroxyprogesterone acetate (MPA) in conjunction with letrozole (LE) in infertile women by propensity score matching (PSM) analysis. A retrospective cohort study. Tertiary-care academic medical center. A total of 3173 infertile women undergoing their first in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) treatment within the period from January 2017 to December 2020. A total of 1068 and 783 patients who underwent a fixed dose of MPA combined with LE and a degressive dose of MPA combined with LE protocols, respectively, were enrolled in this study. The freeze-all approach and later frozen-thawed embryo transfer (FET) were performed in both groups. Propensity score matching (1:1) was performed. The primary outcomes were the dosage of MPA and the incidence of premature luteinizing hormone (LH) surges. The secondary outcomes were the number of oocytes retrieved, the cumulative live birth rate (CLBR) and the fetal malformation rate. We created a perfect match of 478 patients in each group. The dosage of MPA, the LH serum level on the eighth day of stimulation, progesterone (P) level and LH level on the hCG trigger day were significantly higher in the LE + fixed MPA group than in the LE + degressive MPA group (52.1 ± 13.1 mg vs. 44.9 ± 12.5 mg; 5.0 ± 2.7 IU/L vs. 3.7 ± 1.7 IU/L; 0.9 ± 0.5 ng/ml vs. 0.8 ± 0.5 ng/ml; 3.3 ± 2.4 IU/L vs. 2.8 ± 1.9 IU/L; P < 0.01). The duration of Gn, the number of follicles with diameter more than 16mm on trigger day, the estradiol (E2) level on the hCG trigger day were lower in the LE + fixed MPA group than in the LE + degressive MPA group (9.7 ± 1.7 days vs. 10.3 ± 1.5 days; 5.6 ± 3.0 vs. 6.3 ± 3.0; 1752.5 ± 1120.8 pg/ml vs. 1997.2 ± 1108.5 pg/ml; P < 0.001). No significant difference was found in the incidence of premature LH surge, the number of oocytes retrieved, the number of top-quality embryos, clinical pregnancy rate (CPR), CLBR or fetal malformation rate between the two groups. The combination of a degressive MPA dose with LE proved effective in reducing the total MPA dosage with comparable premature LH surge and pregnancy outcomes in women undergoing the PPOS protocol.

Chronological age enhances aging phenomena and protein nitration in oocyte.

The average age of childbearing has increased over the years contributing to infertility, miscarriages, and chromosomal abnormalities largely invoked by an age-related decline in oocyte quality. In this study, we investigate the role of nitric oxide (NO) insufficiency and protein nitration in oocyte chronological aging. Mouse oocytes were retrieved from young breeders (YB, 8-14 weeks [w]), retired breeders (RB, 48-52w) and old animals (OA, 80-84w) at 13.5 and 17 hours after ovulation trigger. They were assessed for zona pellucida dissolution time (ZPDT); ooplasmic microtubule dynamics (OMD); cortical granule (CG) status and spindle morphology (SM), as markers of oocyte quality. Sibling oocytes from RB were exposed to NO supplementation and assessed for aging phenomena (AP). All oocyte cumulus complexes were subjected to fluorescence nitrotyrosine (NT) immunocytochemistry and confocal microscopy to assess morphology and protein nitration. At 13.5 h from hCG trigger, oocytes from RB compared to YB had significantly increased ZPDT (37.8 ± 11.9 vs 22.1 ± 4.1 seconds [s]), OMD (46.9 vs 0%), CG loss (39.4 vs 0%), and decreased normal SM (30.3 vs 81.3%), indicating premature AP that worsened among oocytes from RB at 17 hours post-hCG trigger. When exposed to SNAP, RB AP significantly decreased (ZPDT: 35.1 ± 5.5 vs 46.3 ± 8.9s, OMD: 13.3 vs 75.0% and CG loss: 50.0 vs 93.3%) and SM improved (80.0 vs 14.3%). The incidence of NT positivity was significantly higher in cumulus cells (13.5 h, 46.7 ± 4.5 vs 3.4 ± 0.7%; 17 h, 82.2 ± 2.9 vs 23.3 ± 3.6%) and oocytes (13.5 h, 57.1 vs 0%; 17 h, 100.0 vs 55.5%) from RB compared to YB. Oocytes retrieved decreased with advancing age (29.8 ± 4.1 per animal in the YB group compared to 10.2 ± 2.1 in RB and 4.0 ± 1.6 in OA). Oocytes from OA displayed increased ZPDT, major CG loss, increased OMD and spindle abnormalities, as well as pronuclear formation, confirming spontaneous meiosis to interphase transition. Oocytes undergo zona pellucida hardening, altered spindle and ooplasmic microtubules, and premature cortical granule release, indicative of spontaneous meiosis-interphase transition, as a function of chronological aging. These changes are also associated with NO insufficiency and protein nitration and may be alleviated through supplementation with an NO-donor.

#287 : A Comparison of hCG Trigger Versus Dual Trigger for Final Oocyte Maturation in Poor Ovarian Responders Undergoing Minimal Stimulation

Background and Aims: Traditionally, hCG has been used for oocyte triggering. However, women with poor ovarian response manifest low oocyte yield and compromised occyte quality. More recently, a combination of hCG and GnRHa (dual trigger) has been shown to improve follcile collection yield and oocyte maturation. The aim of the study is tocompare the result of final oocyte maturation and the embryo formation between two groups of poor ovarian responders undergoing minimal stimulation after triggering by hCG alone versus dual trigger. Method: This randomized control trial was conducted at National Assisted Reproductive Center, National Hospital of Obstetrics and Gynecology. Patients defined as poor ovarian responders according to the Bologna criteria were equally divided into two groups: control (hCG trigger) and investigation (dual trigger) groups. The group received the hCG trigger (6500 IU) and the investigation group received the dual trigger (0.2 mg of Triptorelin plus 6500 IU of hCG). Minimal stimulation IVF protocols consist of 5 days of 100mg clomiphene citrate and small amounts of gonadotropin. Results: One hundred and two patients were included in the study, with 51 women in each treatment group. Dual triggering showed a significant higher number of retrieved oocytes (5.35 ± 3.13 vs 4.35 ± 2.44, P=0.038) and metaphase II oocytes (4.25 ± 3.12 vs 3.35 ± 2.02, P=0.043). Although not reaching statistical significances, increases in the number of fertilized oocytes, embryos, and number of top-quality embryos (TQE) were observed. Conclusion: Dual trigger for final oocyte maturation is associated with better IVF outcome in poor ovarian responders undergoing minimal stimulation. Acknowledgements: The authors are grateful to all physicians, administrative staff at the National Assisted Reproductive Technology Center, National Hospital of Obstetrics and Gynecology, Vietnam for allowing and supporting us to undertake this research.

#100 : Can the Dual Trigger be Effective in Improving Oocyte Maturation and Embryo Quality Compared to the HCG Trigger or the GnRH-a Trigger?

Background and Aims: HCG was the standard trigger of final oocyte maturation in IVF cycles. An alternative trigger with gonadotropin releasing hormone agonist (GnRH-a) was effective in reducing OHSS. But GnRH-a trigger induced increased luteal insufficiency and cycle cancellation. A dual trigger (HCG with GnRH-a) was introduced to reduce OHSS, luteal insufficiency and cycle cancellation. This study was designed to compare the effect of dual trigger on final oocyte maturation n embryo quality with conventional HCG trigger and GnRH-a trigger. Method: We conducted this retrospective cohort study of patients who underwent IVF antagonist cycles from Jan. 2020 to Dec. 2022. Patients undergoing their oocyte retrieval 36 hours after trigger with only HCG 10,000 units, or only leuprolide acetate 40 units, or a dual trigger of HCG 5000 units with leuprolide acetate 40 units. Male factor infertility and oocyte donor cycle were excluded. The main outcomes were retrieved mature oocyte rate and fertilization rate. Secondary outcomes include implantation rate and pregnancy rate. Results: Total 3266 patients were included. Dual trigger was in 2279, GnRH-a in 282 and HCG in 705 cycles. Patients using GnRH-a were younger (33.7± 4.0 years) compared to those receiving dual trigger (37.8±2.3 years) and HCG only (37.2±3.2 years) (p&lt;0.01). Because GnRH-a groups were younger, despite low total gonadotropin dose, the larger number of oocytes were retrieved. Dual trigger resulted in no difference in mature oocyte ratio, compared to HCG trigger and GnRH-a trigger (63.0%, 58.3%, 62.8% p: 0.074). Analysis did not show any statistical differences in fertilization rate between the types of triggering methods. Cycel cancellation due to no oocyte recovered from multiple follicles aspirated was shown only in GnRH-a cycle (6 cases. 2.1%). Conclusion: Compared to HCG trigger and GnRH-a trigger, the dual trigger showed no difference in mature oocyte rate and fertilization rate. To reduce OHSS and cycle cancellations, dual trigger could be considered the standard care in IVF without decreasing oocyte quality.

#381 : Can Serum Progesterone Concentration Direct a Fresh or Freeze-All Transfer Strategy in the First In Vitro Fertilisation Cycle?

Background and Aims: The role of progesterone in preparing the endometrium for implantation and sustaining early pregnancy is well established in ART, however the role of serum progesterone measurement within cycles in determining the outcome of embryo transfer (ET) is not defined. This study aimed to examine the interaction between serum progesterone concentration on the day of HCG trigger and choice of freeze-all and fresh transfer strategies on live birth. Method: We retrospectively studied 26661 women (Chengdu Xinan Hospital) commencing their first IVF cycle using autologous gametes between January 2015 and September 2019. We excluded cycles where oocyte retrieval was cancelled or no embryos were available for transfer, cycles where fresh or frozen transfer was determined by patient preference, and when serum progesterone on day of HCG was [Formula: see text] 2.0 or [Formula: see text] 20 oocytes were collected. The primary outcome of interest was live birth after 28 weeks gestation following first ET and expressed as an odds ratio (OR). Results: The predicted odds of live birth were greater in the frozen ET group at all progesterone concentrations. The effect was more pronounced with progressive increase in progesterone concentration (Figure 1) and maintained in both unadjusted and adjusted models. For women &gt;35 years (n=4687), a positive interaction between progesterone and treatment effect was present although the treatment effect curve was flattened (p for interaction = 0.01). Conclusion: In an unselected population undergoing IVF/ICSI, there is an increased chance of pregnancy with a freeze all ET strategy at different progesterone concentrations on HCG trigger day. The effect appears to be dose related with increasing magnitude of effect with rising progesterone concentration. This interaction was also observed in subsets of women with single ET and women &gt; 35 years old, however the benefit of a freeze-all policy appears low in these women.

Effect of Elevated Progesterone Levels on hCG Trigger Day on Clinical Pregnancy Outcome in Short-Acting GnRHa Downregulated Cycles.

Previous studies suggested higher serum progesterone (P) levels were strongly associated with a lower clinical pregnancy rate (CPR) for in vitro fertilization-embryo transfer (IVF-ET). However, the effect of increased serum P levels on the day of human chorionic gonadotropin (hCG) administration on clinical outcomes in short-acting gonadotropin-releasing hormone agonist (GnRHa) downregulated IVF-ET cycles remains unclear. We conducted a retrospective cohort study from January 2017 to December 2021, which included a total of 1664 patients receiving their first short-acting GnRHa IVF-ET cycles at our reproductive medicine centre of Nanjing Drum Tower Hospital. The smooth curve fitting and interaction analysis were employed to analyse the association between the CPR and the serum P levels with different embryo types (cleavage-stage embryo or blastocyst). In addition, total cycles were grouped according to different P levels on the trigger day of hCG administration for further analysis. The CPR of patients with increased serum P level (higher than 1.5 ng/mL) on the hCG day did not decrease. A smoothing curve fitting showed that the CPR did not change obviously with the increase in serum P levels. Subgroup analysis of different types of embryos transferred showed that no correlation was observed between the CPR and serum P levels on the day of hCG administration in cleavage-stage embryo transfer cycles. However, the CPR of patients receiving blastocyst transfer showed a downward trend with the increase in serum P levels. At the same time, an interaction analysis also confirmed that the CPR of blastocyst transfer was more likely to be affected by elevated serum P levels on the hCG day. In the luteal phase short-acting GnRHa downregulated IVF-ET cycles, the elevated serum P levels on the hCG day did not affect the CPR of cleavage-stage embryo transfer but reduced the CPR of blastocyst transfer.

#210 : The Comparison of Agonist Trigger and Dual Trigger in Our IVF Population - A Single Center Retrospective Study

Background: For years, human chorionic gonadotropin (hCG) has been the trigger of choice for oocyte maturation due to its molecular and biological similarity with LH, but its longer half-life compared to LH contributes to the ovarian hyperstimulation syndrome (OHSS) in hyper responders. Besides, hCG lacks FSH activity, which plays a role in the in vitro maturation of oocytes. Gonadotropin-releasing hormone (GnRH) agonists which can bring endogenous release of both FSH and LH and have a shorter mean duration of LH surge, and effectively reduce the incidence of OHSS in high responders. However, the substitution of agonist as trigger is associated with the risk of empty follicle syndrome, increased early pregnancy loss and decreased rates of ongoing pregnancy. The idea of a dual trigger where hCG component could serve as a rescue in case of poor response to GnRH-agonist, occurring in about 2.71% of ART population, and agonist bringing FSH &amp; LH surge simultaneously leading to improved oocyte quality was the basis for present study. Aim &amp; objective: To observe the difference between agonist trigger and dual trigger in various ovarian reserve groups. Materials &amp; Methods: Retrospective cohort study in patients attending Eva fertility clinic &amp; IVF center between 2021-2022. Total patients =157 agonist trigger =57 dual trigger = 100 Age: 24 years to 41 years Average BMI 26 AMH :2.0 ng-6.6 ng/ml Primary outcome: Clinical pregnancy rate &amp; ongoing pregnancy rate Secondary outcome: Blastocyst formation rate Total M2 achieved. Result: Pregnancy’ in (AMH: &lt;2 ng/mL)- no significant difference between the various groups in terms of distribution of Pregnancy ([Formula: see text]2= 0.209, p = 1.000). (Table 1) Pregnancy’ in (AMH: 2-5 ng/mL)- no significant difference ([Formula: see text]2= 0.023, p = 0.880). (Table 2) Pregnancy’ in (AMH: &gt;5 ng/mL)- no significant difference ([Formula: see text]2= 0.286, p = 0.711). (Table 3) Limitation of the study- small sample size, lack of plain hCG trigger group to compare as an arm 3. Conclusion: Dual trigger treatment with GnRH agonist and hCG is not inferior in terms of live birth rate, blastocyst, &amp; M2 oocytes compared to GnRH agonist &amp; hCG trigger apart from avoiding the danger of OHSS.

#290 : Does Extending the Time Interval Between hCG Trigger and Oocyte Retrieval from 36 to 37 Hours Affect the Rate of Euploid Blastocysts?

Background and Aims: Data are lacking regarding the optimal time interval between human chorionic gonadotropin (hCG) administration and ovum pick-up (hCG-OPU interval), and its impact on blastocyst euploidy. Our aim was to compare the blastocyst euploidy rate between IVF cycles with hCG-OPU interval of 36 and 37 h. Method: In this historic cohort study, we reviewed all hCG-triggered, PGT-A, IVF cycles performed in a single clinic, between 2018 and 2022. Commencing in September 2021, clinicians gradually changed the hCG-OPU interval from 37 to 36 h. We compared the outcomes of cycles with hCG-OPU interval of 36 h (35.5-36.5) to 37 h (36.6-37.5). The primary outcome was the number of euploid embryos. Cycles with oocyte donation, and cycles utilized GnRH-agonist triggers or dual-triggers were excluded. Results: The euploidy rates were similar between the 36-h group (n=2,584) and 37 h group (n=5,575; 39.7% vs. 38.8%, respectively, p=0.42). Compared to the 36-h group, patients in the 37-h group were characterized by higher numbers of total oocytes collected (15.9±8.9 vs. 17.3±9.8, respectively, p&lt;0.001), mature (MII) oocytes (8.3±8.2 vs. 9.6±9.6, respectively, p&lt;0.001) and 2PN embryos (9.8±5.5 vs. 10.3±6.4, respectively, p&lt;0.001). On multivariate logistic regression analysis, the hCG-OPU interval was not associated with euploidy (aOR 0.91, 95% CI 0.82-1.01), after controlling for female and male ages, female BMI, and number of oocytes collected. Conclusion: hCG-OPU intervals of 36 and 37 h resulted in similar blastocyst euploidy rates in IVF cycles. This finding has the potential to aid the decision-making processes when managing IVF procedures. The 37-h group was characterized by a lower female age and higher doses of gonadotropins and consequentially more eggs collected, mature eggs and 2PN embryos compared to the patients of the 36 h group. Nonetheless, the two groups had comparable rates of euploid embryos reinforcing our primary finding. Data are presented as mean ± standard deviation or n (%); hCG- Human chorionic gonadotropin; OPU- ovum pickup; BMI- BMI kg/m2, Gonadotropins- in IU; ICSI- Intra cytoplasmic sperm injection. Data are presented as mean ± standard deviation or n (%); hCG- Human chorionic gonadotropin; OPU- ovum pickup; 2PN- 2 Pronuclei.

How to Prevent Early Ovulation/Luteinization During an IVF Cycle

In ovarian stimulation for artificial reproductive medicine, we sometimes encounter progesterone elevation (PL; Premature luteinization) on the day of ovulation trigger. Higher progesterone levels on the ovulation trigger have been indicated to induce adverse effects in pregnancy and implantation. This effect’s mechanism is considered an asynchrony between the embryo and the endometrium. PL is commonly defined as an elevation of serum progesterone over 1.5 ng/ml; however, the threshold values differ from the studies. PL had been evaluated by several predictors such as a single progesterone level, progesterone/ estradiol ratio, and progesterone/oocyte ratio. Some conditions may easily induce PL. In poor responder patients, a higher dose of FSH is used and that hormonal milieu provides a condition for premature luteinization. The physiological mechanism for PL has been studied; however, it is yet clarified. Since PL occurs during ovarian stimulation, FSH administration may contribute to PL. HCG trigger timing may also be an essential factor in raising progesterone. In the cases of premature luteinization, the freeze-all can be an appropriate means to keep pregnancy possibility. On the other hand, some studies indicate that the low success rates are attributable to the low quality of the embryo, not to hormonal or endocrinological disturbances. In this theory, the freeze-all strategy is not enough for a solution. Concerning impaired endometrium receptivity induced at premature luteinization, it has been reported to cause implantation failure. It has been indicated that PL affects pregnancy and live birth rates. Therefore, we are required to prevent PL by selecting appropriate ovarian stimulation protocol to achieve high pregnancy rates, optimal trigger timing, and use of medications such as corticosteroids or metformin that may prevent PL.

#50 : Effect of Dual vs. Single (hCG) Trigger in Maturation Rate of Oocytes in ART

Background and Aims: Due to its similar molecular structures and biological activities, human chorionic gonadotropin (hCG) is used as a substitute for luteinizing hormone (LH) in ART. The weaknesses of using hCG as a trigger are the possibility of ovarian hyperstimulation syndrome in high responders and lacked FSH activity which promotes LH receptor formation in luteinizing granulosa cells, nuclear maturation, and cumulus expansion. GnRH agonist (GnRHa) reduces the development of OHSS and induces a physiological surge similar to the natural menstrual cycle. Because of shorter amplitude and duration of GnRHa-induced LH surge, GnRHa-alone trigger results in a higher early miscarriage rate. Combining these two agents; dual trigger increases oocyte maturation with reduced OHSS. Here we present reports in our clinic to differentiate the dual vs. hCG trigger results. Method: We retrospectively analyzed the data from 68 patients who had undergone antagonist protocol from January 2021-January 2023. The final oocyte maturation was undertaken with a dual trigger with GnRHa (Buserelin 0.3 mg) combined with hCG (r-hCG 250 [Formula: see text]g) ([Formula: see text] = 33) or hCG alone ([Formula: see text] = 35). Results: The mean age of both groups was 34 years old. The AMH level of the dual group ranged from 0.06 – 7.17 ng/mL, and in hCG alone group ranged from 0.16 – 12.3 ng/mL. Women in both groups got similar amounts of follicles and MII oocytes; dual group (14.8 and 12.72 vs. 14.9 and 13). The retrieval rate of oocytes was identical in both groups (86.6% vs. 89.9%). However, the maturation rate of dual group was slightly lower than the hCG group (77% vs. 82%), but it was statistically insignificant (independent t-test p 0.99). Conclusion: We showed that dual trigger was not superior to hCG-alone trigger in terms of maturation rate of oocytes. Analysis of larger data is needed to show the real advantages.

An Innovative Approach of HCG Trigger with Concurrent 1500 IU HCG and 450 IU FSH Utilization for OHSS Avoidance in High Risk Patients - Is it Superior to Dual Trigger

An Innovative Approach of HCG Trigger with Concurrent 1500 IU HCG and 450 IU FSH Utilization for OHSS Avoidance in High Risk Patients - Is it Superior to Dual Trigger

Dual trigger for final oocyte maturation in expected normal responders with a high immature oocyte rate: a randomized controlled trial.

To evaluate whether dual trigger could improve reproductive outcomes in women with low oocyte maturation rates compare to human chorionic gonadotropin (hCG) trigger. This study included expected normal ovarian responders younger than 40 years old whose immature oocyte rate in the previous cycle was more than 50% at the reproductive center from July 2021 to November 2022. A total of 73 patients were enrolled at trigger, including 34 in the hCG trigger group and 39 in the dual trigger group (co-administration of gonadotrophin releasing hormone (GnRH) agonist and hCG, 40 and 34 h prior to oocyte retrieval, respectively). The primary outcome was oocyte maturation rate. There was no significant difference in the number of oocytes retrieved between the two study groups, but the oocyte maturation rate was higher in dual trigger group (84.0% [14.0%] vs. 55.5% [19.8%], p < 0.001). Moreover, there were also higher cumulative pregnancy rate (69.4% vs. 40.0%, p = 0.035) and cumulative live birth rate (66.7% vs. 36.0%, p = 0.022) in dual trigger group. For normal responders with low oocyte maturation rates, the dual trigger may be more effective than the conventional hCG trigger. ClinicalTrials.gov, identifier ChiCTR2100049292.

Triggers in controlled ovarian hyperstimulation

Controlled ovarian hyperstimulation (COH) is a crucial component of assisted reproductive technologies like intrauterine insemination (IUI) and in vitro fertilization (IVF). Triggers in COH play a pivotal role in maturation of the follicles in their final stages and optimizing the timing of egg retrieval, which is very important for the collection of maximum eggs and for a good success rate. Human chorionic gonadotropin (hCG) is used as a standard method for the final follicular maturation and ovulation. HCG has the similar effect as luteinizing hormone (LH) with a half-life of 5–7 days. Now a days, gonadotropin-releasing hormone agonist (GnRH-a) trigger has been used with the target to reduce OHSS for the induction of final follicular maturation and ovulation. Based on the results of various studies, using the GnRH-a trigger leads to defects in the luteal phase resulting in reduced implantation and clinical pregnancy rates and also increasing abortion rates in fresh embryo transfer cycles compared to the routine IVF cycle with hCG triggering. In this review, we examined the benefits, problems and also ways to reform various triggers used for ovulation.