title: Substituting HCG with GnRH agonist to trigger final follicular maturation--a retrospective comparison of three different ovarian stimulation protocols.
abstract: The study retrospectively evaluated the influence of triggering final oocyte maturation with gonadotrophin-releasing hormone (GnRH) agonist on the outcome of IVF cycles. Four hundred and sixty consecutive women admitted to the IVF unit during a 4-year period were enrolled in the study. Ovarian stimulation characteristics and clinical pregnancy rate were compared between three groups: patients at risk of developing ovarian hyperstimulation syndrome (OHSS), undergoing either the long GnRH-agonist protocol (agonist group) or the flexible multidose GnRH-antagonist protocol who received GnRH-agonist for final oocyte maturation (antagonist-agonist group); and patients not at risk of developing severe OHSS undergoing the flexible multidose GnRH-antagonist protocol who received human chorionic gonadotrophin (HCG) for final oocyte maturation (antagonist-HCG group). Implantation and clinical pregnancy rates were lowest in the antagonist-agonist group despite the fact that no difference were was observed in fertilization rates between the groups. Moreover, the high-responder antagonist-agonist group required shorter stimulation and had higher numbers of oocytes retrieved as compared with the high-responder agonist-group. No case of severe OHSS was observed in the antagonist-agonist group. The use of flexible multidose GnRH-antagonist protocol with GnRH-agonist for final oocyte maturation, in high-responder patients, eliminates the risk of OHSS but results in decreased implantation and pregnancy rates.
authors.affiliation: Department of Obstetrics and Gynecology, Barzilai Medical Centre, Ashkelon, Israel. raoulo@barzi.health.gov.il
authors.forename: Raoul
authors.initials: R
authors.lastname: Orvieto
authors.forename: Jacob
authors.initials: J
authors.lastname: Rabinson
authors.forename: Simion
authors.initials: S
authors.lastname: Meltzer
authors.forename: Efraim
authors.initials: E
authors.lastname: Zohav
authors.forename: Eyal
authors.initials: E
authors.lastname: Anteby
authors.forename: Roy
authors.initials: R
authors.lastname: Homburg
mesh_terms: D000328:Adult; D006063:Chorionic Gonadotropin / Q000627:therapeutic use*; D010064:Embryo Implantation / Q000187:drug effects; D005260:Female; D005300:Fertility Agents, Female / Q000627:therapeutic use*; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists* / Q000037:antagonists & inhibitors; D006801:Humans; D007247:Infertility, Female / Q000188:drug therapy*; D009865:Oocytes / Q000187:drug effects / Q000254:growth & development; D006080:Ovarian Follicle / Q000187:drug effects* / Q000254:growth & development; D016471:Ovarian Hyperstimulation Syndrome / Q000150:complications; D010062:Ovulation Induction / Q000009:adverse effects / Q000379:methods*; D011247:Pregnancy; D018873:Pregnancy Rate; D012189:Retrospective Studies
chemical_list: D006063:Chorionic Gonadotropin; D005300:Fertility Agents, Female; D007987:Gonadotropin-Releasing Hormone