The use of gonadotropin-releasing hormone (GnRH) agonist to induce oocyte maturation after cotreatment with GnRH antagonist in high-risk patients undergoing in vitro fertilization prevents the risk of ovarian hyperstimulation syndrome: a prospective randomized controlled study.
OBJECTIVE
To determine whether there are any differences in the incidence of ovarian hyperstimulation syndrome (OHSS) and implantation rates in high-risk patients undergoing IVF using a protocol consisting of GnRH agonist trigger after cotreatment with GnRH antagonist or hCG trigger after dual pituitary suppression protocol.


METHODS
Prospective randomized controlled trial.


METHODS
University-based tertiary fertility center.


METHODS
Sixty-six patients under 40 years of age with polycystic ovarian syndrome, polycystic ovarian morphology, or previous high response undergoing IVF.


METHODS
Patients were randomized to an ovarian stimulation protocol consisting of either GnRH agonist trigger after cotreatment with GnRH antagonist (study group) or hCG trigger after dual pituitary suppression with a GnRH agonist (control group). Both groups received luteal phase and early pregnancy supplementation with IM progesterone (P), and patients in the study group also received E(2) patches and their doses were adjusted according to the serum levels.


METHODS
Incidence of OHSS and implantation rate.


RESULTS
None of the patients in the study group developed any form of OHSS compared with 31% (10/32) of the patients in the control group. There were no significant differences in the implantation (22/61 [36.0%] vs. 20/64 [31.0%]), clinical pregnancy (17/30 [56.7%] vs. 15/29 [51.7%]), and ongoing pregnancy rates (16/30 [53.3%] vs. 14/29 [48.3%]) between the study and control groups, respectively.


CONCLUSIONS
The use of a protocol consisting of GnRH agonist trigger after GnRH antagonist cotreatment combined with adequate luteal phase and early pregnancy E(2) and P supplementation reduces the risk of OHSS in high-risk patients undergoing IVF without affecting implantation rate.
Engmann
Lawrence
L
Center for Advanced Reproductive Services, Department of Obstetrics and Gynecology, Dowling South Building, University of Connecticut Health Center, Farmington, Connecticut 06030-6224, USA. lengmann@uchc.edu
DiLuigi
Andrea
A
Schmidt
David
D
Nulsen
John
J
Maier
Donald
D
Benadiva
Claudio
C
D000328:Adult; D003278:Contraceptives, Oral, Hormonal / Q000097:blood / Q000627:therapeutic use; D010064:Embryo Implantation / Q000187:drug effects; D004958:Estradiol / Q000097:blood; D005260:Female; D005300:Fertility Agents, Female / Q000097:blood / Q000627:therapeutic use*; D005307:Fertilization in Vitro; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists / Q000031:analogs & derivatives / Q000037:antagonists & inhibitors / Q000627:therapeutic use; D006727:Hormone Antagonists / Q000627:therapeutic use*; D006801:Humans; D015994:Incidence; D007247:Infertility, Female / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D016729:Leuprolide / Q000627:therapeutic use; D007986:Luteinizing Hormone / Q000097:blood; D016017:Odds Ratio; D009865:Oocytes / Q000187:drug effects* / Q000254:growth & development; D016471:Ovarian Hyperstimulation Syndrome / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D010062:Ovulation Induction / Q000009:adverse effects*; D011085:Polycystic Ovary Syndrome / Q000097:blood / Q000150:complications / Q000503:physiopathology / Q000628:therapy; D011247:Pregnancy; D018873:Pregnancy Rate; D011374:Progesterone / Q000097:blood; D011446:Prospective Studies; D018570:Risk Assessment; D020554:Sperm Injections, Intracytoplasmic; D016896:Treatment Outcome
D003278:Contraceptives, Oral, Hormonal; D005300:Fertility Agents, Female; D006727:Hormone Antagonists; D007987:Gonadotropin-Releasing Hormone; D011374:Progesterone; D004958:Estradiol; D007986:Luteinizing Hormone; D016729:Leuprolide; C061018:ganirelix