title: Factors that predict the probability of a successful clinical outcome after induction of oocyte maturation with a gonadotropin-releasing hormone agonist.
abstract: OBJECTIVE
  To determine factors predicting cycle success after in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) in high-risk patients undergoing controlled ovarian stimulation with a gonadotropin-releasing hormone (GnRH) antagonist protocol with a GnRH agonist to induce oocyte maturation.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  University-based tertiary fertility center.
  
  
  METHODS
  Women who underwent a GnRH antagonist protocol during IVF-ICSI cycles and received a GnRH agonist for oocyte maturation.
  
  
  METHODS
  GnRH-agonist trigger.
  
  
  METHODS
  Clinical and ongoing pregnancy rates and any occurrence of ovarian hyperstimulation syndrome (OHSS).
  
  
  RESULTS
  The serum luteinizing hormone (LH) level on the day of trigger of oocyte maturation was the single most important predictor of clinical pregnancy. Patients with a peak estradiol (E(2)) level ≥4,000 pg/mL also had statistically significant higher serum LH on the day of the GnRH-agonist trigger and had a higher clinical pregnancy rate compared with those with a peak E(2) level <4,000 pg/mL, although the two groups had comparable numbers of oocytes retrieved. No patients developed OHSS.
  
  
  CONCLUSIONS
  Serum LH and E(2) levels ≥4,000 pg/mL on the day of the GnRH-agonist trigger are important predictors of success in patients at high risk of OHSS development. As none of the patients in this high-risk population developed OHSS, the GnRH-agonist trigger is effective in the prevention of this iatrogenic complication.
authors.affiliation: Center for Advanced Reproductive Services, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Connecticut Health Center, Farmington, Connecticut 06030-6224, USA.
authors.forename: Nicole
authors.initials: N
authors.lastname: Kummer
authors.forename: Claudio
authors.initials: C
authors.lastname: Benadiva
authors.forename: Richard
authors.initials: R
authors.lastname: Feinn
authors.forename: Jessica
authors.initials: J
authors.lastname: Mann
authors.forename: John
authors.initials: J
authors.lastname: Nulsen
authors.forename: Lawrence
authors.initials: L
authors.lastname: Engmann
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists* / Q000031:analogs & derivatives / Q000037:antagonists & inhibitors / Q000097:blood / Q000494:pharmacology; D006062:Gonadotropins / Q000494:pharmacology; D006801:Humans; D008297:Male; D009865:Oocytes / Q000187:drug effects / Q000254:growth & development*; D010062:Ovulation Induction / Q000379:methods*; D011237:Predictive Value of Tests; D011247:Pregnancy; D018873:Pregnancy Rate / Q000639:trends*; D012189:Retrospective Studies; D020554:Sperm Injections, Intracytoplasmic / Q000639:trends; D016896:Treatment Outcome
chemical_list: D006062:Gonadotropins; D007987:Gonadotropin-Releasing Hormone; C061018:ganirelix