Absence of luteal phase defect and spontaneous pregnancy in IVF patients despite GnRH-agonist trigger and "freeze all policy" without luteal phase support: a report of four cases.
Human chorionic gonadotropin (hCG) is commonly used for final oocyte maturation in "in vitro fertilization" (IVF)-treatment cycles, however, the main important risk is development of severe ovarian hyperstimulation syndrome (OHSS). OHSS can almost be avoided by using gonadotrophin-releasing-hormone agonist for final oocyte maturation in an antagonist protocol. However, primarily this approach lead to a very poor reproductive outcome, despite the use of a standard luteal phase support. The reason seems to be severe luteolysis. Obviously, luteolysis post-gonadotropin-releasing-hormone-agonist (post-GnRH-a) trigger is individual specific, and not all patients will develop a complete luteolysis, as expected previously. Luteolysis can been reverted by the administration of hCG. Unprotected intercourse around the time of ovulation induction and oocyte retrieval can lead to a spontaneous conception in IVF treatment and, endogenous hCG, produced by the trophoblast, will rescue the corpora lutea. Therefore, one should not rely on complete luteolysis after GnRH-a triggering and, especially patients for egg donation and pre-implantation-genetic diagnosis for single gene disorder, have to be counselled to avoid unprotected intercourse.
a Private Novafertil IVF Center , Konya , Turkey .
Ali Sami
AS
Gurbuz
b Department of Obstetrics and Gynecology , Mugla Sitki Kocman University, Medical Facility , Mugla , Turkey .
Ruya
R
Deveer
a Private Novafertil IVF Center , Konya , Turkey .
Necati
N
Ozcimen
c Department of Obstetrics and Gynecology , Baskent University, Medical Faculty , Konya , Turkey .
Emel Ebru
EE
Ozcimen
d IVI-GCC Fertility , Abu Dhabi , UAE .
Barbara
B
Lawrenz
e NOVA IVI Fertility , Ahmedabad , India , and.
Manish
M
Banker
f IVI Madrid , Madrid , Spain.
Juan Antonio
JA
Garcia-Velasco
d IVI-GCC Fertility , Abu Dhabi , UAE .
Human Mousavi
HM
Fatemi
D000328:Adult; D006063:Chorionic Gonadotropin / Q000627:therapeutic use; D003338:Corpus Luteum; D005260:Female; D005300:Fertility Agents, Female / Q000627:therapeutic use*; D005307:Fertilization in Vitro; D005640:Follicle Stimulating Hormone / Q000627:therapeutic use; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists / Q000031:analogs & derivatives* / Q000037:antagonists & inhibitors / Q000627:therapeutic use; D006801:Humans; D007247:Infertility, Female / Q000628:therapy*; D008183:Luteal Phase; D003341:Luteolysis; D054315:Oocyte Retrieval; D016471:Ovarian Hyperstimulation Syndrome / Q000517:prevention & control; D010062:Ovulation Induction / Q000379:methods*; D011247:Pregnancy; D018873:Pregnancy Rate
D006063:Chorionic Gonadotropin; D005300:Fertility Agents, Female; D007987:Gonadotropin-Releasing Hormone; D005640:Follicle Stimulating Hormone; C062876:cetrorelix
GnRH-agonist-trigger; luteal deficiency; luteal phase support; ovarian hyperstimulation syndrome; spontaneous conception