title: Retrospective comparison of GnRH agonist trigger with HCG trigger in GnRH antagonist cycles in anticipated high-responders.
abstract: All IVF-ICSI cycles carried out between October 2009 and October 2012 using GnRH agonist (GnRHa) ovulation trigger (n = 62) followed by a single dose of HCG plus progesterone and oestradiol in the luteal phase because of anticipated ovarian hypertsimulation were retrospectively compared with historic control cycles using HCG trigger (n = 29) and standard luteal phase support. Women's mean age, body mass index, anti-Müllerian hormone, FSH, LH, starting and total stimulation dose, number of follicles, oocytes, embryos, fertilization, implantation, polycystic ovary syndrome, ICSI, live birth and ongoing pregnancy rates per embryo transfer were similar (GnRHa 40.7% versus HCG 35.0%). For each started cycle, GnRHa resulted in 11.4% higher (statistically non-significant) live birth and ongoing pregnancy rate (OR 1.73, CI 0.64 to 4.69), with a similar difference for double-embryo transfers (OR 1.62, CI 0.44 to 6.38) and less need for freezing all embryos (9.7% versus 27.6%; P = 0.04). Incidence of mild-to-moderate OHSS was 16.2% with GnRHa trigger and 31.0% with HCG trigger) and no severe OHSS in the former. The addition of single low-dose HCG in the luteal phase after GnRHa trigger for suspected high-responders reduced the incidence of OHSS with good clinical outcomes, compared with HCG trigger.
authors.affiliation: Midland Fertility Services, 3rd Floor, Centre House, Court Parade, Aldridge WS9 8LT, UK. Electronic address: adrija65@yahoo.com.
authors.forename: Adrija Kumar
authors.initials: AK
authors.lastname: Datta
authors.affiliation: Midland Fertility Services, 3rd Floor, Centre House, Court Parade, Aldridge WS9 8LT, UK.
authors.forename: Abey
authors.initials: A
authors.lastname: Eapen
authors.affiliation: Midland Fertility Services, 3rd Floor, Centre House, Court Parade, Aldridge WS9 8LT, UK.
authors.forename: Heidi
authors.initials: H
authors.lastname: Birch
authors.affiliation: Midland Fertility Services, 3rd Floor, Centre House, Court Parade, Aldridge WS9 8LT, UK.
authors.forename: Anitha
authors.initials: A
authors.lastname: Kurinchi-Selvan
authors.affiliation: Midland Fertility Services, 3rd Floor, Centre House, Court Parade, Aldridge WS9 8LT, UK.
authors.forename: Gillian
authors.initials: G
authors.lastname: Lockwood
mesh_terms: D000328:Adult; D002064:Buserelin / Q000627:therapeutic use; D006063:Chorionic Gonadotropin / Q000737:chemistry*; D015925:Cryopreservation; D004958:Estradiol / Q000008:administration & dosage; D005260:Female; D005307:Fertilization in Vitro; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists* / Q000037:antagonists & inhibitors*; D006801:Humans; D016471:Ovarian Hyperstimulation Syndrome / Q000517:prevention & control; D010060:Ovulation / Q000187:drug effects; D010062:Ovulation Induction; D061214:Patient Safety; D011247:Pregnancy; D011256:Pregnancy Outcome; D018873:Pregnancy Rate; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D006063:Chorionic Gonadotropin; D007987:Gonadotropin-Releasing Hormone; D004958:Estradiol; D002064:Buserelin
keywords: GnRH-agonist trigger; OHSS; human chorionic gonadotropin; low-dose HCG; luteal phase support