Consistent high clinical pregnancy rates and low ovarian hyperstimulation syndrome rates in high-risk patients after GnRH agonist triggering and modified luteal support: a retrospective multicentre study.

@article{Iliodromiti2013ConsistentHC,
  title={Consistent high clinical pregnancy rates and low ovarian hyperstimulation syndrome rates in high-risk patients after GnRH agonist triggering and modified luteal support: a retrospective multicentre study.},
  author={Stamatina Iliodromiti and Christophe Blockeel and Kelton Tremellen and Richard Fleming and Herman Tournaye and Peter Humaidan and Scott M Nelson},
  journal={Human reproduction},
  year={2013},
  volume={28 9},
  pages={
          2529-36
        }
}
STUDY QUESTION Are clinical pregnancy rates satisfactory and the incidence of OHSS low after GnRH agonist trigger and modified intensive luteal support in patients with a high risk of ovarian hyperstimulation syndrome (OHSS)? SUMMARY ANSWER GnRH agonist trigger combined with 1500 IU hCG at the time of oocyte retrieval and subsequent estradiol and progesterone replacement in OHSS high-risk patients can facilitate fresh embryo transfer with high clinical pregnancy rates and a low risk of severe… Expand
GnRH agonist trigger with intensive luteal phase support vs. human chorionic gonadotropin trigger in high responders: an observational study reporting pregnancy outcomes and incidence of ovarian hyperstimulation syndrome
TLDR
In conclusion, GnRHa trigger is associated with similar pregnancy rates with hCG trigger and a significant reduction in hospitalization for severe OHSS after an intention to treat analysis was performed. Expand
Does HCG Luteal Support Improve Pregnancy Rates in GnRH Antagonist IVF Cycles and GnRH Agonist Trigger? A Randomized Controlled Trial
TLDR
Giving a single dose of hCG 1500 units immediately after ovum pick-up significantly improves pregnancy rates without increasing the incidence of severe OHSS. Expand
The freeze-all strategy versus agonist triggering with low-dose hCG for luteal phase support in IVF/ICSI for high responders: a randomized controlled trial.
TLDR
This study offers the first comparative analysis of two common strategies applied to women performing IVF/ICSI with a high risk to develop OHSS, and suggests a fresh embryo transfer with intensified luteal phase support may still not avoid the risk of moderate-to-severe ovarian hyperstimulation syndrome. Expand
How frequent is severe ovarian hyperstimulation syndrome after GnRH agonist triggering in high-risk women? A systematic review and meta-analysis.
The aim of the present systematic review and meta-analysis was to assess the incidence of severe ovarian hyperstimulation syndrome (OHSS) after triggering of final oocyte maturation withExpand
GnRH agonist with low-dose hCG (dual trigger) is associated with higher risk of severe ovarian hyperstimulation syndrome compared to GnRH agonist alone
TLDR
Dual trigger for final oocyte maturation using GnRHa and low-dose hCG is associated with a significantly increased risk of severe OHSS compared to GnRH alone, however, dual trigger may be associated withA modest increase in oocyte yield, both in terms of number and maturity. Expand
Is It Possible to Prevent Ovarian Hyperstimulation Syndrome by Gonadotropin-Releasing Hormone Agonist Triggering and Modified Luteal Support in Patients With Polycystic Ovarian Morphology?
TLDR
It is concluded that OHSS may still occur with the use of a GnRH agonist trigger combined with low-dose hCG supplementation protocol in women with polycystic ovary syndrome (PCOS) or PCO morphology and that “freeze-all” policy also will not completely eliminate OHSS development in high-risk women. Expand
Gonadotropin-releasing hormone agonist for ovulation trigger – OHSS prevention and use of modified luteal phase support for fresh embryo transfer
TLDR
How the GnR Ha trigger concept adds safety and efficacy to modern IVF in terms of OHSS prevention is discussed and the optimal luteal phase management after GnRHa trigger in fresh embryo transfer cycles is discussed. Expand
Gonadotropin-releasing hormone agonist triggering with concomitant administration of low doses of human chorionic gonadotropin or a freeze-all strategy in high responders
TLDR
The live birth rate with GnRH agonist triggering and concomitant use of 1500 IU of hCG immediately after oocyte retrieval was similar to that obtained with the freeze-all approach and FET in a subsequent cycle. Expand
GnRH Agonist Trigger and LH Activity Luteal Phase Support versus hCG Trigger and Conventional Luteal Phase Support in Fresh Embryo Transfer IVF/ICSI Cycles—A Systematic PRISMA Review and Meta-analysis
TLDR
The most recent trials reported LBRs close to unity indicating that individualization of the LH activity LPS improved the luteal phase deficiency reported in the first GnRHa trigger studies, but LPS optimization is needed to further limit OHSS in the subgroup of normoresponder patients. Expand
Luteal Support with very Low Daily Dose of Human Chorionic Gonadotropin after Fresh Embryo Transfer as an Alternative to Cycle Segmentation for High Responders Patients Undergoing Gonadotropin-Releasing Hormone Agonist-Triggered IVF
TLDR
In non-PCO women, high responders submitted to COS with the GnRH-antagonist protocol and Gn RH-agonist trigger, CS strategy was associated with higher IR and LBR than the strategy including fresh ET followed by luteal phase support with a low daily hCG dose, and CS appears to be advisable. Expand
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References

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TLDR
GnRHa triggering of final oocyte maturation followed by one bolus of 1500 IU HCG seems to prevent early onset OHSS in high-risk patients and secure the reproductive outcome. Expand
Oocyte maturation employing a GnRH agonist in combination with low-dose hCG luteal rescue minimizes the severity of ovarian hyperstimulation syndrome while maintaining excellent pregnancy rates.
TLDR
If a low dose of hCG support on the day of oocyte retrieval can maintain good pregnancy rates, while not abolishing the protective effect of an agonist trigger on the development of severe OHSS, then employing a GnRH agonist (protocol) in combination with low-dose hCG luteal support produces excellent clinical pregnancy rates. Expand
GnRHa trigger and individualized luteal phase hCG support according to ovarian response to stimulation: two prospective randomized controlled multi-centre studies in IVF patients.
STUDY QUESTION Does a GnRH agonist (GnRHa) trigger followed by a bolus of 1.500 IU hCG in a group of patients at risk of ovarian hyperstimulation syndrome (OHSS) reduce the OHSS incidence comparedExpand
Severe early ovarian hyperstimulation syndrome following GnRH agonist trigger with the addition of 1500 IU hCG.
TLDR
It would be prudent to avoid hCG luteal rescue and freeze all embryos for future transfer in such women particularly when there are ≥18 follicles with 10-14 mm diameters even with few larger follicles. Expand
A lower ongoing pregnancy rate can be expected when GnRH agonist is used for triggering final oocyte maturation instead of HCG in patients undergoing IVF with GnRH antagonists.
TLDR
Lower probability of ongoing pregnancy can be expected when GnRH agonist is used for triggering final oocyte maturation instead of HCG in patients undergoing ovarian stimulation for IVF with GnRH antagonists. Expand
The use of gonadotropin-releasing hormone (GnRH) agonist to induce oocyte maturation after cotreatment with GnRH antagonist in high-risk patients undergoing in vitro fertilization prevents the risk of ovarian hyperstimulation syndrome: a prospective randomized controlled study.
TLDR
The use of a protocol consisting of GnRH agonist trigger after GnRH antagonist cotreatment combined with adequate luteal phase and early pregnancy E(2) and P supplementation reduces the risk of OHSS in high-risk patients undergoing IVF without affecting implantation rate. Expand
Endometrial gene expression in the early luteal phase is impacted by mode of triggering final oocyte maturation in recFSH stimulated and GnRH antagonist co-treated IVF cycles.
TLDR
Endometrial gene-expression findings support the clinical reports of a non-significant difference in live birth rates between the GnRH agonist trigger and the hCG trigger, when the Gn RH agonisttrigger is followed by a bolus of 1500 IU hCG at 35 h post trigger in addition to the standard luteal phase support. Expand
1,500 IU human chorionic gonadotropin administered at oocyte retrieval rescues the luteal phase when gonadotropin-releasing hormone agonist is used for ovulation induction: a prospective, randomized, controlled study.
TLDR
A small bolus of hCG in the GnR Ha group secured the luteal phase, resulting in a comparable reproductive outcome in the two groups, however, a nonsignificant difference of 7% in delivery rates justifies further studies to refine the use of GnRHa for ovulation induction. Expand
Rescue of corpus luteum function with peri-ovulatory HCG supplementation in IVF/ICSI GnRH antagonist cycles in which ovulation was triggered with a GnRH agonist: a pilot study.
TLDR
Triggering of ovulation with GnRHa supplemented with 1500 IU HCG 35 h later (group 3) seems to secure a normal luteal phase and a normal clinical pregnancy outcome. Expand
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TLDR
A GnRH agonist effectively triggers the final oocyte maturation in oocyte donors without negatively affecting implantation, pregnancy or miscarriage rates, and this regime effectively eliminates the risk of OHSS. Expand
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