title: Gonadotropin-releasing hormone agonist (GnRHa) trigger - State of the art.
abstract: GnRH agonist (GnRHa) trigger for final oocyte maturation in GnRH antagonist co-treated IVF/ICSI cycles significantly reduces the risk of ovarian hyperstimulation syndrome (OHSS). GnRHa trigger followed by modifications of the standard luteal phase support (modified luteal phase support) secures fresh transfer in the majority of patients with excellent reproductive outcomes. In freeze all cycles (segmented cycles) GnRHa trigger allows oocyte retrieval with a minimal risk of early onset OHSS and good reproductive outcomes in subsequent frozen thaw cycles. Overall, two different luteal phase support strategies have been proposed when a fresh transfer is performed after GnRHa trigger. These involve either boosting the endogenous steroid production or adding exogenous steroids. The present review discusses the advancement of GnRHa trigger in fresh and segmented cycles and how a modified luteal phase support policy in fresh transfer cycles results in good reproductive outcomes as well as a high safety in terms of OHSS reduction. Finally, the new concept of an individualized luteal phase support policy taking the number of pre-ovulatory follicles into account when planning a fresh transfer in GnRHa triggered IVF/ICSI cycle is discussed.
authors.affiliation: The Fertility Clinic Skive Regional Hospital, Skive, Denmark; Hospital Universitario Dexeus, Barcelona, Spain. Electronic address: cardos@dexeus.com.
authors.forename: Carlos
authors.initials: C
authors.lastname: Dosouto
authors.affiliation: The Fertility Clinic Skive Regional Hospital, Skive, Denmark; Faculty of Health, Aarhus University, Aarhus, Denmark.
authors.forename: Thor
authors.initials: T
authors.lastname: Haahr
authors.affiliation: The Fertility Clinic Skive Regional Hospital, Skive, Denmark; Faculty of Health, Aarhus University, Aarhus, Denmark.
authors.forename: Peter
authors.initials: P
authors.lastname: Humaidan
mesh_terms: D000818:Animals; D003340:Corpus Luteum Maintenance / Q000187:drug effects*; D005260:Female; D005300:Fertility Agents, Female / Q000009:adverse effects / Q000627:therapeutic use*; D005307:Fertilization in Vitro; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists* / Q000037:antagonists & inhibitors / Q000378:metabolism; D006801:Humans; D059471:In Vitro Oocyte Maturation Techniques; D007247:Infertility, Female / Q000628:therapy; D050498:Live Birth; D054315:Oocyte Retrieval / Q000009:adverse effects; D016471:Ovarian Hyperstimulation Syndrome / Q000453:epidemiology / Q000517:prevention & control*; D065851:Ovarian Reserve / Q000187:drug effects; D010062:Ovulation Induction / Q000009:adverse effects; D057285:Precision Medicine; D011247:Pregnancy; D018873:Pregnancy Rate; D011966:Receptors, LHRH / Q000819:agonists* / Q000037:antagonists & inhibitors / Q000378:metabolism; D012306:Risk; D015398:Signal Transduction / Q000187:drug effects*
chemical_list: D005300:Fertility Agents, Female; C484844:GNRHR protein, human; D011966:Receptors, LHRH; D007987:Gonadotropin-Releasing Hormone
keywords: GnRH agonist; In vitro fertilization; Luteal phase support; OHSS; hCG