Ovulation induction and luteal support with GnRH agonist in patients at high risk for hyperstimulation syndrome

Abstract

The aim of this study was to compare GnRHa trigger and luteal addition of triptorelin to hCG trigger for final oocyte maturation in women at high risk for OHSS undergoing IVF. A total of 423 patients were divided in two groups both stimulated using antagonist short protocol. Gonadotropins 75–150 UI/day were started on day 2–5, GnRH antagonist was added when the lead follicle was >14 mm and the final trigger was obtained with hCG 250 µg or triptorelin 0.2 mg. The luteal phase was supported with progesterone alone in the hCG group, with progesterone plus triptorelin 0.1 every other day from embryo transfer in the triptorelin group. In the triptorelin group we did neither have to suspend any embryo transfer, nor we have any early clinical OHSS. In the control group, 13 patients were suspended due to symptomatic high risk for OHSS and two patients developed a clinically significant OHSS. No statistically significant difference was observed in terms of clinical and ongoing pregnancy rates and implantation rates. Our results indicate that a protocol including GnRHa as trigger and an intensive luteal phase supported with GnRHa is safer than a standard antagonist protocol using hCG as trigger. It displays similar results, therefore it can be used as the first choice in patients at high risk for OHSS.

Chinese abstract

本文研究目的是对于接受体外受精存在卵泡过度刺激综合征（OHSS）高风险妇女比较采用曲普瑞林（GnRHa）诱发排卵及黄体支持与绒毛膜促性腺激素诱发排卵（hCG）情况。423名分为两组，均接受GnRHa短方案治疗。月经第2-5天接受促性腺激素75-150IU/L，当优势卵泡>14mm时加入GnRHa，最后采用hCG250mg或曲普瑞林0.2mg扳机诱发排卵。对于hCG组单独应用黄体酮进行黄体支持，曲普瑞林组从胚胎移植日起应用黄体酮，同时隔日加用曲普瑞林0.1mg。结果发现曲普瑞林组既没有暂停任何胚胎移植，也没有临床早期OHSS的发生。对照组中，13名患者因存在OHSS高风险而终止胚胎移植，2名患者发展为重度OHSS。就临床妊娠率、持续妊娠率及种植率而言，两组无显著统计学差异。我们的研究结果显示与标准拮抗剂方案和hCG扳机相比，GnRHa扳机及黄体期GnRHa持续支持方案更加安全有效。因此，该方法可以成为存在OHSS高风险患者的首选。

• GnRH agonist
• in vitro fertilization
• luteal phase support
• ovarian hyperstimulation syndrome
• trigger

Acknowledgements

Clinicians: Dr Cappato M. and Dr Galbignani E.; Nurses: Ratti E. and Gamba M. We also thank the Director of the Maternal-Pediatric Department Prof. Luigi Frigerio for his support.

Declaration of interest

The authors report no declarations of interest.