Gonadotropin-releasing hormone agonist trigger is a better alternative than human chorionic gonadotropin in PCOS undergoing IVF cycles for an OHSS Free Clinic: A Randomized control trial.
OBJECTIVE
The objective of this study is to evaluate if gonadotropin-releasing hormone agonist (GnRHa) trigger is a better alternative to human chorionic gonadotropin (hCG) in polycystic ovary syndrome (PCOS) of Indian origin undergoingin vitrofertilization (IVF) cycles with GnRH antagonist for the prevention of ovarian hyperstimulation syndrome (OHSS).


METHODS
Prospective randomized control trial.


METHODS
Tertiary care center.


METHODS
A total of 227 patients diagnosed with PCOS, undergoing IVF in an antagonist protocol were recruited and randomly assigned into two groups: Group A (study group): GnRHa trigger 0.2 mg (n= 92) and Group B (control group): 250 μg of recombinant hCG as trigger (n= 101) 35 h before oocyte retrieval. We chose segmentation strategy, freezing all embryos in both the groups.


METHODS
Continuous variables were expressed as mean ± standard deviation independent samplet-test and Kolmogorov-Smirnov test were used for continuous variables which were normally distributed and Mann-Whitney U-test for data not normally distributed.


METHODS
Primary outcome: OHSS (mild, moderate, and severe) rates. Secondary outcomes: Maturity rate of the oocytes, fertilization rate, availability of top quality embryos on day 3 (Grade 1 and Grade 2).


RESULTS
The incidence of moderate to severe OHSS in the hCG group was 37.6% and 0% in the GnRHa group withP< 0.001. The GnRHa group had significantly more mature oocytes retrieved (19.1 ± 11.7 vs. 14.1 ± 4.3), more fertilized oocytes (15.6 ± 5.6 vs. 11.7 ± 3.6), and a higher number of top quality cleavage embryos on day 3 (12.9 ± 4.7 vs. 7.5 ± 4.3) than the hCG group.


CONCLUSIONS
The most effective strategy which significantly eliminates the occurrence of OHSS in PCOS following ovarian stimulation in antagonist IVF cycles is the use of GnRHa trigger yielding more mature oocytes and good quality embryos when compared with hCG trigger.
Department of Reproductive Medicine, Milann - The Fertility Center, Bengaluru, Karnataka, India.
Deepika
D
Krishna
Department of Reproductive Medicine, Milann - The Fertility Center, Bengaluru, Karnataka, India.
Snehal
S
Dhoble
Department of Reproductive Medicine, Milann - The Fertility Center, Bengaluru, Karnataka, India.
Gautham
G
Praneesh
Department of Reproductive Medicine, Milann - The Fertility Center, Bengaluru, Karnataka, India.
Suvarna
S
Rathore
Department of Reproductive Medicine, Milann - The Fertility Center, Bengaluru, Karnataka, India.
Amit
A
Upadhaya
Department of Reproductive Medicine, Milann - The Fertility Center, Bengaluru, Karnataka, India.
Kamini
K
Rao
Antagonist; gonadotropin-releasing hormone agonist trigger; human chorionic gonadotropin trigger; ovarian hyperstimulation syndrome; polycystic ovary syndrome