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Improved clinical outcomes and lower OHSS risk with GnRH agonist trigger and hCG incorporated luteal support, compared to hCG trigger in GnRH-antagonist protocol for anticipated high responders
Abstract   Open access   Peer reviewed

Improved clinical outcomes and lower OHSS risk with GnRH agonist trigger and hCG incorporated luteal support, compared to hCG trigger in GnRH-antagonist protocol for anticipated high responders

A.K. Datta, A. Eapen, A. Kurinchi-Selvan and G. Lockwood
Fertility and sterility, Vol.100(3 Supplement), pp.S517-S517
09/2013
DOI: 10.1016/j.fertnstert.2013.07.243
url
https://doi.org/10.1016/j.fertnstert.2013.07.243View
Published (Version of record) Open Access

Abstract

Objective To compare the clinical outcomes and incidence of OHSS between GnRH-agonist trigger [incorporating hCG, estrogen and progesterone luteal phase support (LPS)] and hCG trigger in GnRH-antagonist protocol for high responders of IVF/ICSI. Design Retrospective study of consecutive women at high risk of OHSS who underwent IVF/ICSI (one cycle/ patient) with GnRH-antagonist protocol. Materials and Methods Women with AMH levels >25 pmol/l, who had IVF/ICSI using GnRH-antagonist in a tertiary-level fertility clinic between Oct 09 and Oct 12. Final oocyte maturation was done by GnRH-agonist (n=62) or hCG (n=29). The continuous and categorical variables are compared by t-test/ Fisher's and χ2 tests respectively. Results No difference in the mean age, BMI, AMH, FSH, LH, starting/ total dose of FSH; proportion of PCOS, ICSI; mean number of eggs (17.9vs14.1, p=0.06) embryos (9.8vs7.1, p=0.13); fertilization (54.6%vs55.6%, p=0.77) and implantation (30.8%vs28.9%, p=0.94) rates between GnRH-agonist and hCG group. Blastocysts transfer (54.7%vs35.0%, p=0.04) was more with GnRH-agonist. One clinical miscarriage in each group and 4 ‘biochemical’ with GnRH-agonist. Clinical pregnancy (42.6%vs40%, p=0.85) and ongoing pregnancy rates (40.7%vs35.0%, p=0.74) per embryo-transfer were similar between GnRH-agonist and hCG. Ongoing pregnancy 11.4% higher with GnRH-agonist and similar twin rates (GnRH-agonist: 13.2%vs hCG: 22.2%, p=0.42) when double-embryo transferred. Fewer mild-moderate (16.2%vs 31.0%, p=0.10), no severe OHSS and no hospitalization with GnRH-agonist, while 1 severe OHSS with hCG; less need for freeze-all embryos (9.7%vs27.6%, p=0.04) for risk of secondary-OHSS with GnRH-agonist. Conclusion Our study reassures that addition of single 1500 iu hCG as LPS following GnRH-agonist trigger results in as good, if not better treatment outcomes and further reduction of OHSS, when compared with hCG trigger. Adequately powered randomised control trial is required to confirm this.

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