Different Timing of Adjuvant Low Dose hCG and GnRH Agonist Trigger Protocol, in OHSS High-Risk Patient with Peak E2 Level <4000 pg/mL

Authors

DOI:

https://doi.org/10.21613/GORM.2020.1133

Keywords:

Controlled ovarian stimulation, Gonadotropin-releasing hormone agonist trigger, Live birthLow 1, 500 IU Human chorionic gonadotropin, Ovarian hyperstimulation syndrome

Abstract

OBJECTIVE: The aim of the study is to compare the live birth rates between 1,500 I.U. of Human chorionic gonadotropin at the time of Gonadotropin-releasing hormone agonist trigger day or 35-36 h later on the oocyte pick-up day, without affecting the risk of significant ovarian hyperstimulation syndrome development in high-risk patients with peak E2 level <4,000 pg/mL

STUDY DESIGN: This single-center prospective cohort study encompassed the period from March 2016 to March 2018 year. A total of 216 patients entered for final analysis, underwent a flexible antagonist protocol, intracytoplasmic sperm injection, and embryo transfer on the 3rd or 5th day in autologous cycles. Patients were randomized in one of two groups: Group A- Dual trigger group - 1,500 IU of Human chorionic gonadotropin at the time of Gonadotropin-releasing hormone agonist trigger day and Group B- 1,500 IU of Human chorionic gonadotropin 35-36 h later, on the oocyte pick-up day. To compare the two groups, we used nonparametric and parametric statistical tests. Significant differences were considered all values of p<0.05.

RESULTS: There is no significant difference between the two (A vs B) groups according to the average number of retrieved oocytes (13.08 vs 14.41 p=0.08), M II oocytes (10.5 vs 10.95 p=0.46), GV (1.24 vs 1.52 p=0.09, the fertility rate (68.46% vs 64.04% p=0.07). The dual trigger group (A) had a significantly higher live birth rate (62.29% vs 42.37% p<0.05) compared with the Gonadotropin-releasing hormone-a trigger group (B). There were no cases of moderate or severe ovarian hyperstimulation syndrome in both groups.

CONCLUSION: Our study shows that in hyper responders where the E2 peak is <4,000 pg/mL, the two approaches to the final oocyte maturation trigger have a correct outcome of the results, both in terms of the results from the in vitro fertilization and the low risk of ovarian hyperstimulation syndrome appearance.

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Author Biographies

Emilija Zoran Petanovska Kostova, First private General Hospital Remedika

Department for in vitro fertilization.

Velentina Sotirovska, First private General Hospital Remedika

Department for in vitro fertilization.

Gligor Dimitrov, First private General Hospital Remedika

Department for in vitro fertilization.

Snezana Stojkovska, First private General Hospital Remedika

Department for in vitro fertilization.

Makjuli Hadzi Lega, First private General Hospital Remedika

Department for in vitro fertilization.

Daniela Stojanovska, First private General Hospital Remedika

Department for in vitro fertilization.

Nikoleta Stamenkovska, First private General Hospital Remedika

Department for in vitro fertilization.

Liljana Simjanovska, First private General Hospital Remedika

Department for in vitro fertilization.

Zoranco Petanovski, First private General Hospital Remedika

Department for in vitro fertilization.

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Published

2020-12-25

How to Cite

1.
Petanovska Kostova EZ, Sotirovska V, Dimitrov G, Stojkovska S, Hadzi Lega M, Stojanovska D, Stamenkovska N, Simjanovska L, Petanovski Z. Different Timing of Adjuvant Low Dose hCG and GnRH Agonist Trigger Protocol, in OHSS High-Risk Patient with Peak E2 Level &lt;4000 pg/mL. Gynecol Obstet Reprod Med [Internet]. 2020Dec.25 [cited 2021Jan.21];26(3):203-9. Available from: https://www.gorm.com.tr/index.php/GORM/article/view/1133

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Section

Reproductive Medicine: Endocrinology and Infertility