Gonadotropin-releasing Hormone Agonist for Ovulation Trigger - OHSS Prevention and Use of Modified Luteal Phase Support for Fresh Embryo Transfer

Overview

Journal Ups J Med Sci

Specialty General Medicine

Date 2020 May 6

PMID 32366146

Citations 7

Authors

Juan Carlos Castillo

Thor Haahr

Maria Martinez-Moya

Peter Humaidan

Affiliations

Soon will be listed here.

Abstract

The introduction of gonadotrophin-releasing hormone agonist (GnRHa) trigger greatly impacted modern IVF treatment. Patients at low risk of ovarian hyperstimulation syndrome (OHSS) development, undergoing fresh embryo transfer and GnRHa trigger can be offered a virtually OHSS-free treatment with non-inferior reproductive outcomes by using a modified luteal phase support in terms of small boluses of human chorionic gonadotrophin (hCG), daily recombinant luteinizing hormone LH (rLH) or GnRHa. In the OHSS risk patient, GnRHa trigger can safely be performed, followed by a 'freeze-all' policy with a minimal risk of OHSS development and high live birth rates in the subsequent frozen embryo transfer cycle. Importantly, GnRHa trigger opened the 'black box' of the luteal phase, promoting research in the most optimal steroid levels during the luteal phase. GnRHa trigger allows high-dose gonadotropin stimulation to achieve the optimal number of oocytes and embryos needed to ensure the highest chance of live birth. This review thoroughly discusses how the GnRHa trigger concept adds safety and efficacy to modern IVF in terms of OHSS prevention. Furthermore, the optimal luteal phase management after GnRHa trigger in fresh embryo transfer cycles is discussed.

Citing Articles

Minerals and the Menstrual Cycle: Impacts on Ovulation and Endometrial Health.

Kapper C, Oppelt P, Ganhor C, Gyunesh A, Arbeithuber B, Stelzl P Nutrients. 2024; 16(7).

PMID: 38613041 PMC: 11013220. DOI: 10.3390/nu16071008.

Micronized natural progesterone (Seidigestan) vs GnRH antagonists for preventing the LH surge during controlled ovarian stimulation (PRO_NAT study): study protocol of a randomized clinical trial.

Martinez-Moya M, Guerrero J, Girela J, Pitas A, Bernabeu A, Bernabeu R Front Endocrinol (Lausanne). 2024; 15:1350154.

PMID: 38577571 PMC: 10991791. DOI: 10.3389/fendo.2024.1350154.

Long-acting gonadotropin-releasing hormone agonist trigger in fertility preservation cycles before chemotherapy.

Massarotti C, Stigliani S, Gazzo I, Lambertini M, Anserini P ESMO Open. 2023; 8(4):101597.

PMID: 37421801 PMC: 10485390. DOI: 10.1016/j.esmoop.2023.101597.

GnRHa trigger-the story of the ugly duckling.

Humaidan P, Haahr T F S Rep. 2023; 4(2 Suppl):15-19.

PMID: 37223771 PMC: 10201294. DOI: 10.1016/j.xfre.2023.02.011.

Ovarian protection and safety of gonadotropin-releasing hormone agonist after cervical cancer surgery: systematic review and meta-analysis.

Yuan J, Lai Y, Li T Ann Transl Med. 2022; 10(7):409.

PMID: 35530944 PMC: 9073801. DOI: 10.21037/atm-22-928.

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