title: GnRH agonist for triggering of final oocyte maturation: time for a change of practice?
abstract: BACKGROUND
  GnRH agonist (GnRHa) triggering has been shown to significantly reduce the occurrence of ovarian hyperstimulation syndrome (OHSS) compared with hCG triggering; however, initially a poor reproductive outcome was reported after GnRHa triggering, due to an apparently uncorrectable luteal phase deficiency. Therefore, the challenge has been to rescue the luteal phase. Studies now report a luteal phase rescue, with a reproductive outcome comparable to that seen after hCG triggering.
  
  
  METHODS
  This narrative review is based on expert presentations and subsequent group discussions supplemented with publications from literature searches and the authors' knowledge. Moreover, randomized controlled trials (RCTs) were identified and analysed either in fresh IVF cycles with embryo transfer (ET), oocyte donation cycles or cycles without ET; risk differences were calculated regarding pregnancy rate and OHSS rate.
  
  
  RESULTS
  In fresh IVF cycles with ET (9 RCTs) no OHSS was reported after GnRHa triggering [0% incidence in the GnRHa group: risk difference 5% (with 95% CI: -0.07 to 0.02)]. Importantly, the delivery rate improved significantly after modified luteal support [6% risk difference in favour of the HCG group (95% CI: -0.14 to 0.2)] when compared with initial studies with conventional luteal support [18% risk difference (95% CI: -0.36 to 0.01)]. In oocyte donation cycles (4 RCTs) the OHSS incidence is 0% [10% risk difference (95% CI: 0.02-0.40)].
  
  
  CONCLUSIONS
  GnRHa triggering is a valid alternative to hCG triggering, resulting in an elimination of OHSS. After modified luteal support there is now a non-significant difference of 6% in delivery rate in favour of hCG triggering.
authors: The Fertility Clinic, Skive Regional Hospital, Resenvej 25, Skive, Denmark. peter.humaidan@viborg.rm.dk
authors: P
authors: P
authors: Humaidan
authors: S
authors: S
authors: Kol
authors: E G
authors: EG
authors: Papanikolaou
mesh_terms: D000328:Adult; D019317:Evidence-Based Medicine; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists*; D006801:Humans; D015994:Incidence; D008183:Luteal Phase / Q000187:drug effects; D015201:Meta-Analysis as Topic; D009866:Oogenesis / Q000187:drug effects*; D016471:Ovarian Hyperstimulation Syndrome / Q000139:chemically induced / Q000453:epidemiology; D011247:Pregnancy; D011256:Pregnancy Outcome; D018873:Pregnancy Rate; D027724:Reproductive Techniques, Assisted; D012307:Risk Factors
chemical_list: D007987:Gonadotropin-Releasing Hormone