To determine the ability of a GnRH agonist to trigger final egg maturation and reduce the risk of ovarian hyperstimulation in GnRH-antagonist controlled IVF and Donor Egg cycles. Retrospective Cohort. A “Lupron Trigger” was used in 85 cases from June 2004 until October 2005 when the risk of OHSS was judged to be high. A single dose of Lupron (leuprolide acetate) 2 mg was given SC (in place of hCG 5,000 IU) 35 hours before planned egg retreival. Luteal support was begun the day after egg retrieval (progesterone (P4) 50 mg IM daily and estradiol (E2) 2 mg PO bid). Fifteen cycles were Egg Donor; 70 were standard IVF. In 17 cases a prior cycle in which hCG had been used as a trigger was available for comparison (of which 7 were donor egg cycles). Results are given as mean ± standard deviation. At the time of the trigger, E2 was 3821 pg/mL (±1327) and the number of follicles larger than 10 mm was 29.6 (±9.7). The morning after the Lupron Trigger, the mean LH was 54.2 IU/L (±29.9) and P4 was 8.9 ng/mL (±4.5). After use of a Lupron Trigger: 1. None of the 85 cases developed any degree of OHSS despite being high risk. 2. In three cases there was an aberrant surge response [case 1: LH 2.2 IU/L, P4 12.8 ng/mL, 22 eggs but none fertilized; case 2: LH 8.0 IU/L, P4 5.5 ng/mL, 23 eggs of which only 2 were mature; case 3: LH 10 IU/L, P4 1.2 ng/mL, no eggs from first 5 aspirates]. In 6 other cases, despite an adequate surge response, many fewer than expected eggs were obtained (n=3: 9 eggs from 23 large follicles, 20 from 50, 24 from 60), or few were mature (n=4: 2 of 23, 0 of 23, 4 of 21, 11 of 20), and/or few fertilized (n=5: 3 of 11, 1 of 9, 2 of 11, 1 of 16, 1 of 24). 3. In the fresh IVF cycles with transfer (n=57), implantation rate was 16.9%, 44% had a clinical pregnancy, 33% miscarried, and 29% have ongoing or delivered pregnancies. However, these disappointing outcomes were not seen in either the Donor Egg cases (of 15 transfers, the implantation rate was 63%; 77% became clinical pregnant and none have miscarried) or the subsequent cryo-thaw cycles of the initial IVF cases (of 13 transfers, the implantation rate was 59.4%; 76.9% became pregnant and 61.5% are ongoing or delivered). 4. The paired analysis (n=17) showed lower egg yield in the Lupron Trigger cases (58% of follicles 13 mm or larger yielded an egg) vs. the hCG trigger cases (79%). Use of the Lupron Trigger reduces (if not eliminates) the risk of OHSS. However, the Lupron Trigger failed to induce normal final egg maturation in 10 of 85 cases. Moreover, the yield of eggs was reduced in the paired analysis, and pregnancy outcomes were low in the fresh IVF (but not Donor Egg or frozen IVF) cycles. This descrepancy suggests an endometrial defect with use of the Lupron Trigger. We advise caution in adopting the Lupron Trigger as the primary strategy to avert OHSS in antagonist controlled cycles.