GnRH Agonist with Low-dose HCG (dual Trigger) is Associated with Higher Risk of Severe Ovarian Hyperstimulation Syndrome Compared to GnRH Agonist Alone

Overview

Journal J Assist Reprod Genet

Publisher Springer

Specialties Genetics
Reproductive Medicine

Date 2016 Jun 29

PMID 27349252

Citations 18

Authors

Kathleen E ONeill

Suneeta Senapati

Ivy Maina

Clarisa Gracia

Anuja Dokras

Affiliations

Soon will be listed here.

Abstract

Purpose: The purpose of this study was to compare rates of ovarian hyperstimulation syndrome (OHSS) after using gonadotropin-releasing hormone agonists (GnRHa) alone and GnRHa in combination with low-dose human chorionic gonadotropin (hCG, dual trigger) for final oocyte maturation in women undergoing controlled ovarian hyperstimulation (COH).

Methods: A retrospective cohort study was conducted at an academic center. Study population included 108 women who received GnRHa trigger and 66 women who received dual trigger (GnRHa + low-dose [1000 IU] hCG trigger). The main outcome measure was OHSS. Secondary outcomes included total oocyte yield and oocyte maturity.

Results: The incidence of early OHSS was significantly higher after dual trigger than GnRHa trigger (8.6 vs 0 %). Moreover, four of the six patients that developed OHSS developed severe OHSS. Logistic modeling revealed that the combination of age, BMI, baseline AFC, and E2 >4000 pg/mL was predictive of OHSS with an area under the receiver operating characteristic curve of 0.84 and was superior to each factor alone. Adjusted analyses revealed that dual trigger was associated with a higher number of total oocytes (adjusted OR 1.27; 95 % confidence interval, 1.18, 1.38) and percentage of mature oocytes (AOR 1.10; 95 % confidence interval, 1.03, 1.17) obtained compared to GnRHa trigger alone.

Conclusions: 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 with a modest increase in oocyte yield, both in terms of number and maturity.

Citing Articles

GnRH agonist-only trigger, compared to dual trigger, reduces oocyte retrieval rate in high responders without affecting cumulative live birth rate.

Wang Y, Yi Y, Guu H, Chen Y, Kung H, Chang J Front Endocrinol (Lausanne). 2024; 15:1461317.

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Effect of GnRH agonist trigger with or without low-dose hCG on reproductive outcomes for PCOS women with freeze-all strategy: a propensity score matching study.

Wang Q, Wan Q, Li T, Wang X, Hu Y, Zhong Z Arch Gynecol Obstet. 2023; 309(2):679-688.

PMID: 38032411 DOI: 10.1007/s00404-023-07285-1.

Dual trigger and the impact on oocyte quality and embryo development: a Brazilian cohort.

Kozlowski I, Rosa V, Francisquini C, Schuffner A JBRA Assist Reprod. 2023; .

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Using GnRH agonists in combination with hCG in antagonist ART cycles: A SCOPING Review of recent evidences.

Singh N, Kashyap A, Patel G, Vatsa R JBRA Assist Reprod. 2023; .

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Hormonal profile in early luteal phase after triggering ovulation with gonadotropin-releasing hormone agonist in high-responder patients.

Martazanova B, Mishieva N, Vedikhina I, Kirillova A, Korneeva I, Ivanets T Front Endocrinol (Lausanne). 2022; 13:834627.

PMID: 36046787 PMC: 9420862. DOI: 10.3389/fendo.2022.834627.

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