title: Assessing the adequacy of gonadotropin-releasing hormone agonist leuprolide to trigger oocyte maturation and management of inadequate response.
abstract: OBJECTIVE
  To compare outcomes of in vitro fertilization (IVF) cycles with adequate versus inadequate response to the gonadotropin-releasing hormone (GnRH) agonist trigger rescued with the use of human chorionic gonadotropin (hCG) retrigger, and to identify risk factors associated with an inadequate trigger.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Private practice.
  
  
  METHODS
  Women at high risk for ovarian hyperstimulation syndrome who underwent an autologous IVF cycle and used GnRH agonist to trigger oocyte maturation before oocyte retrieval.
  
  
  METHODS
  Patients were triggered with GnRH agonist for final oocyte maturation before retrieval. Patients with an inadequate response, defined by low post-trigger serum LH and P concentrations or failure to recover oocytes after aspiration of several follicles, were retriggered with hCG.
  
  
  METHODS
  Number of oocytes retrieved, fertilization rate, clinical pregnancy, and live birth.
  
  
  RESULTS
  Two percent of patients triggered with GnRH agonist had an inadequate response and were retriggered with hCG. There was no statistically significant difference in clinical outcomes between the cycles that were retriggered with hCG and successful GnRH agonist triggers. Low body mass index, low baseline LH, and higher total dosage of gonadotropins required for stimulation were associated with an increased risk of having an inadequate response to the GnRH agonist trigger.
  
  
  CONCLUSIONS
  A small minority of patients triggered with GnRH agonist had an inadequate response. Rescheduling of oocyte retrieval after hCG retrigger yielded similar IVF outcomes. Evaluation of trigger response based on serum LH and P concentrations is time dependent. Patient characteristics suggestive of hypothalamic hypofunction were predictive of an inadequate response to the GnRH agonist trigger.
authors.affiliation: Shady Grove Fertility Reproductive Science Center, Rockville, Maryland. Electronic address: frank.chang@integramed.com.
authors.forename: Frank E
authors.initials: FE
authors.lastname: Chang
authors.affiliation: Shady Grove Fertility Reproductive Science Center, Rockville, Maryland; Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institutes of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland.
authors.forename: Stephanie A
authors.initials: SA
authors.lastname: Beall
authors.affiliation: Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institutes of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland.
authors.forename: Jeris M
authors.initials: JM
authors.lastname: Cox
authors.affiliation: Shady Grove Fertility Reproductive Science Center, Rockville, Maryland.
authors.forename: Kevin S
authors.initials: KS
authors.lastname: Richter
authors.affiliation: Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institutes of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland.
authors.forename: Alan H
authors.initials: AH
authors.lastname: DeCherney
authors.affiliation: Shady Grove Fertility Reproductive Science Center, Rockville, Maryland.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Levy
mesh_terms: D000328:Adult; D006063:Chorionic Gonadotropin / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D005298:Fertility; D005300:Fertility Agents, Female / Q000009:adverse effects / Q000627:therapeutic use*; D005307:Fertilization in Vitro; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists*; D006801:Humans; D007246:Infertility / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D016729:Leuprolide / Q000627:therapeutic use*; D050498:Live Birth; D007986:Luteinizing Hormone / Q000097:blood; D054315:Oocyte Retrieval; D009865:Oocytes / Q000187:drug effects*; D010053:Ovary / Q000187:drug effects* / Q000378:metabolism / Q000503:physiopathology; D010062:Ovulation Induction / Q000009:adverse effects / Q000379:methods*; D011247:Pregnancy; D018873:Pregnancy Rate; D011374:Progesterone / Q000097:blood; D019233:Retreatment; D012189:Retrospective Studies; D012307:Risk Factors; D017211:Treatment Failure
chemical_list: D006063:Chorionic Gonadotropin; D005300:Fertility Agents, Female; D007987:Gonadotropin-Releasing Hormone; D011374:Progesterone; D007986:Luteinizing Hormone; D016729:Leuprolide
keywords: Gonadotropin-releasing hormone (GnRH) agonist; human chorionic gonadotropin (hCG); in vitro fertilization (IVF); leuprolide acetate; retrigger