A lower ongoing pregnancy rate can be expected when GnRH agonist is used for triggering final oocyte maturation instead of HCG in patients undergoing IVF with GnRH antagonists.
BACKGROUND
Eliciting an endogenous LH surge by GnRH-agonist for the induction of final oocyte maturation may be more physiological compared with the administration of HCG. However, the efficacy of this intervention in patients treated for IVF with GnRH antagonists remains to be assessed.


METHODS
106 patients were randomized to receive either 10 000 IU urinary HCG or 0.2 mg Triptorelin for triggering final oocyte maturation. Ovarian stimulation for IVF was performed with a fixed dose of 200 IU recombinant FSH and GnRH antagonist was started on stimulation day 6. Luteal phase was supported with micronized vaginal progesterone and oral estradiol. The study was monitored continuously for safety and stopping rules were established.


RESULTS
No significant differences were present in the number of cumulus-oocyte complexes retrieved, in the proportion of metaphase II oocytes, in fertilization rates or in the number and quality of the embryos transferred between the two groups. However, a significantly lower probability of ongoing pregnancy in the GnRH agonist arm prompted discontinuation of the trial, according to the stopping rules established (odds ratio 0.11; 95% confidence interval 0.02-0.52).


CONCLUSIONS
Lower probability of ongoing pregnancy can be expected when GnRH agonist is used for triggering final oocyte maturation instead of HCG in patients undergoing ovarian stimulation for IVF with GnRH antagonists.
Centre of Reproductive Medicine, Dutch-Speaking Brussels Free University, Belgium. stratis.kolibianakis@otenet.gr
E M
EM
Kolibianakis
A
A
Schultze-Mosgau
A
A
Schroer
A
A
van Steirteghem
P
P
Devroey
K
K
Diedrich
G
G
Griesinger
D000328:Adult; D006063:Chorionic Gonadotropin / Q000378:metabolism*; D004958:Estradiol / Q000008:administration & dosage; D004967:Estrogens / Q000378:metabolism; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods*; D005640:Follicle Stimulating Hormone / Q000008:administration & dosage; D007987:Gonadotropin-Releasing Hormone / Q000037:antagonists & inhibitors*; D006801:Humans; D008183:Luteal Phase; D008677:Metaphase; D009865:Oocytes / Q000166:cytology* / Q000378:metabolism; D010062:Ovulation Induction / Q000379:methods; D011247:Pregnancy; D018873:Pregnancy Rate; D011374:Progesterone / Q000008:administration & dosage; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000737:chemistry; D016896:Treatment Outcome; D017329:Triptorelin Pamoate / Q000008:administration & dosage; D014465:Ultrasonics
D006063:Chorionic Gonadotropin; D004967:Estrogens; D011994:Recombinant Proteins; D017329:Triptorelin Pamoate; D007987:Gonadotropin-Releasing Hormone; D011374:Progesterone; D004958:Estradiol; D005640:Follicle Stimulating Hormone