title: GnRH agonist trigger for the induction of oocyte maturation in GnRH antagonist IVF cycles: a SWOT analysis.
abstract: Gonadotrophin releasing hormone agonist (GnRHa) trigger is effective in the induction of oocyte maturation and prevention of ovarian hyperstimulation syndrome during IVF treatment. This trigger concept, however, results in early corpora lutea demise and consequently luteal phase dysfunction and impaired endometrial receptivity. The aim of this strenghths, weaknesses, opportunities and threats analysis was to summarize the progress made over the past 15 years to optimize ongoing pregnancy rates after GnRHa trigger. The advantages and potential drawbacks of this type of triggering are reviewed. The current approach to the management of GnRHa trigger in autologous cycles is based on the peak serum oestradiol level or follicle number and aims at a fresh embryo transfer or a segmentation approach with elective cryopreservation policy. We recommend intensive luteal support with transdermal oestradiol and intramuscular progesterone alone if peak serum oestradiol is 4000 or more pg/ml after GnRHa trigger or dual trigger with GnRHa and HCG 1000 IU if peak serum oestradiol is less than 4000 pg/mL. On the contrary, we recommend HCG 1500 IU 35 h after GnRHa trigger if there are less than 25 follicles, or freeze all oocytes or embryos if there are over 25 follicles.
authors.affiliation: Department of Obstetrics and Gynecology, Center for Advanced Reproductive Services, University of Connecticut School of Medicine, 2 Batterson Park Road, Farmington, CT, USA. Electronic address: lengmann@uchc.edu.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Engmann
authors.affiliation: Department of Obstetrics and Gynecology, Center for Advanced Reproductive Services, University of Connecticut School of Medicine, 2 Batterson Park Road, Farmington, CT, USA.
authors.forename: Claudio
authors.initials: C
authors.lastname: Benadiva
authors.affiliation: The Fertility Clinic, Skive Regional Hospital and Faculty of Health, Aarhus University, Resenvej 25, 7800 Skive, Denmark.
authors.forename: Peter
authors.initials: P
authors.lastname: Humaidan
mesh_terms: D003338:Corpus Luteum / Q000187:drug effects; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods; D007987:Gonadotropin-Releasing Hormone / Q000037:antagonists & inhibitors*; D006801:Humans; D008183:Luteal Phase / Q000187:drug effects; D018587:Oocyte Donation; D009865:Oocytes / Q000187:drug effects / Q000254:growth & development; D010062:Ovulation Induction / Q000379:methods*; D011247:Pregnancy; D018873:Pregnancy Rate; D016896:Treatment Outcome
chemical_list: D007987:Gonadotropin-Releasing Hormone
keywords: GnRH agonist trigger; IVF; OHSS; pregnancy rates