title: Intensified ovarian stimulation in a GnRH antagonist protocol with agonist triggering: a prospective, clinical feasibility study.
abstract: The threat of severe ovarian hyperstimulation syndrome (OHSS) and the increase in discomfort for the patient has limited the feasibility of maximizing the oocyte yield per treatment cycle. A gonadotrophin-releasing hormone (GnRH) antagonist protocol with agonist triggering and vitrification of all 2PN oocytes can eliminate the risk of OHSS. This prospective, single-centre, cohort study in 30 good-responder IVF patients ≤ 36 years reports the feasibility of arbitrarily intensifying stimulation in a GnRH antagonist protocol in terms of tolerability, safety and efficacy. Ovarian stimulation was performed with 225-375IU FSH, induction of final oocyte maturation with 0.2mg GnRH agonist followed by vitrification of all 2 pronuclear (2PN) oocytes and repetitive vitrified-warmed embryo transfer cycles. Main outcomes were severe OHSS incidence, tolerability, assessed by a questionnaire, and cumulative live birth rate. On average, 17 oocytes were retrieved (range 4-42) and 8.4 oocytes at the 2PN stage were cryopreserved (range 3-22). No case of severe OHSS was observed (0%, 95 CI 0-11.4%). Tolerability was good. The cumulative live birth rate per patient undergoing at least one vitrified-warmed embryo transfer was 26.9% (7/26, 95% CI 13.7-46.1%). This approach can be explored in future larger-sized controlled studies.
authors.affiliation: Department of Obstetrics and Gynecology, University Clinic of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Griesinger
authors.forename: Henriette
authors.initials: H
authors.lastname: Berndt
authors.forename: Laura
authors.initials: L
authors.lastname: Schultz
authors.forename: Askan
authors.initials: A
authors.lastname: Schultze-Mosgau
authors.forename: Klaus
authors.initials: K
authors.lastname: Diedrich
authors.forename: Sören
authors.initials: S
authors.lastname: von Otte
mesh_terms: D000328:Adult; D001723:Birth Rate; D015331:Cohort Studies; D015925:Cryopreservation; D004624:Embryo Transfer; D005260:Female; D005307:Fertilization in Vitro; D005640:Follicle Stimulating Hormone / Q000494:pharmacology; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists / Q000037:antagonists & inhibitors*; D006728:Hormones / Q000494:pharmacology; D006801:Humans; D015994:Incidence; D016471:Ovarian Hyperstimulation Syndrome / Q000453:epidemiology / Q000517:prevention & control; D010062:Ovulation Induction / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D006728:Hormones; D007987:Gonadotropin-Releasing Hormone; D005640:Follicle Stimulating Hormone