'Luteal coasting' after GnRH agonist trigger - individualized, HCG-based, progesterone-free luteal support in 'high responders': a case series.
This study reports 21 IVF cases with excessive ovarian response, who received gonadotrophin-releasing hormone agonist (GnRHa) triggering for final oocyte maturation, followed by a human chorionic gonadotrophin (HCG)-based, progesterone-free, luteal support, individually timed ('luteal coasting') according to endogenous luteal progesterone concentrations. One patient developed a brief early-onset moderate ovarian hyperstimulation syndrome (OHSS) condition. Six clinical pregnancies were achieved, two of which have resulted in live births thus far. To further individualize the luteal phase support post GnRHa trigger, the same principle that holds for follicular coasting, used in the context of OHSS prevention, may be valid. Monitoring luteal progesterone concentrations from the day of oocyte retrieval, and administering a bolus of HCG (1500 IU) when the concentration drops significantly, seems to facilitate fresh embryo transfer, even in patients with excessive ovarian responses.
Department of Obstetrics and Gynecology, IVF Unit, Rambam Health Care Campus, Haifa, Israel. Electronic address: skol@rambam.health.gov.il.
Shahar
S
Kol
Department of Obstetrics and Gynecology, IVF Unit, Rambam Health Care Campus, Haifa, Israel.
Tatiana
T
Breyzman
Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.
Linoy
L
Segal
The Fertility Clinic, Skive Regional Hospital, Faculty of Health, Aarhus University, Aarhus, Denmark and Faculty of Health, Odense University, Odense, Denmark.
Peter
P
Humaidan
D000328:Adult; D006063:Chorionic Gonadotropin / Q000627:therapeutic use*; D015331:Cohort Studies; D004624:Embryo Transfer; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods; D006801:Humans; D008183:Luteal Phase / Q000187:drug effects*; D008297:Male; D054315:Oocyte Retrieval; D010062:Ovulation Induction / Q000379:methods*; D057285:Precision Medicine; D011247:Pregnancy; D011374:Progesterone / Q000627:therapeutic use; D055815:Young Adult
D006063:Chorionic Gonadotropin; D011374:Progesterone
GnRHa trigger; HCG; luteal coasting; luteal support; ovarian hyperstimulation syndrome