Efficacy of different trigger managements on in vitro fertilization and embryo transfer outcome_Chinese Journal of Evidence-Based Medicine

Authors：

LI Ya ¹ , LIU Jing ¹ , XIE Lijuan ¹ , RAO Jinning ¹ , TAN Shiqiao ² ,  ZHONG Ying ¹

1. Center for Reproductive Medicine, Jinxin Research Institute for Reproductive Medicine and Genetics, Chengdu Jinjiang Hospital for Maternal and Child, Chengdu, 610066, P.R.China;
2. Department of Gynecology and Obstetrics, West China Second University Hospital, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Chengdu, 610000, P.R.China;

Corresponding author：

ZHONG Ying, Email: zy0118@vip.126.com

Keywords：

Polycystic ovary syndrome; Ovarian hyperstimulation syndrome; Antagonist; Gonadotropin-releasing hormone agonist; Human chorionic gonadotropin

DOI：

10.7507/1672-2531.201903062

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Abstract Full text Figures/Tables Video References Cited by

Objectives To evaluate and compare the clinical impact of different methods of trigger in polycystic ovary syndrome (PCOS) with high ovarian response undergoing in vitro fertilization-embryo transfer (IVF-ET) cycles.Methods A total of 323 PCOS patients with high ovarian response in an gonadotrophin-releasing hormone antagonist protocol in our reproductive medical center from January 1^st, 2017 to December 31^st, 2017 were included. Then they were divided into two groups based on the different trigger modes: Group A: gonadotrophin-releasing hormone agonist (GnRH-a) with low dose human chorionic gonadotrophin (HCG); Group B: HCG as trigger. Analysis and comparison of the general data of the two groups of patients, ovulation induction cycle treatment, embryo laboratory indicators and resuscitation cycle treatment outcome were performed retrospectively.Results There were no significant differences in baseline such as ages, BMI, startup dose of Gn, the total dosage of drugs, promote ovulation days and so on (P>0.05). The serum E₂ level on trigger day in group A was significantly higher than those in group B (7 256.94±2 031.92 vs. 6 200.26±1 001.44, P<0.05). There were no significant differences in the retrieved oocytes (23.90±7.99 vs. 23.81±7.15), binuclear fertilization rate (58.19% vs. 56.30%), and the number of frozen embryos (12.81±5.45 vs. 11.07±5.36) between two groups (P>0.05). There were also no significant differences between two groups in the incidence of moderate to severe OHSS (5.98% vs. 7.87%), clinical pregnancy rate (59.28% vs. 57.53%), implantation rate (41.05% vs. 38.24%), miscarriage rate (9.28% vs. 8.22%) and live birth rate (47.42% vs. 41.10%) during the frozen-thawed cycles (P>0.05).Conclusions For high responders of PCOS patients with GnRH antagonist protocol, using GnRH-a with low dose HCG as trigger maybe could decrease the incidence of moderate to severe OHSS. Embryo resuscitation and transfer cycle can also obtain ideal outcome.

Citation： LI Ya, LIU Jing, XIE Lijuan, RAO Jinning, TAN Shiqiao, ZHONG Ying. Efficacy of different trigger managements on in vitro fertilization and embryo transfer outcome. Chinese Journal of Evidence-Based Medicine, 2019, 19(9): 1024-1029. doi: 10.7507/1672-2531.201903062 Copy

1.	March WA, Moore VM, Willson KJ, et al. The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria. Hum Reprod, 2010, 25(2): 544-551.
2.	Chang WY, Knochenhauer ES, Bartolucci AA, et al. Phenotypic spectrum of polycystic ovary syndrome: clinical and biochemical characterization of the three major clinical subgroups. Fertil Steril, 2005, 83(6): 1717-1723.
3.	Fatemi HM, Garcia-Velasco J. Avoiding ovarian hyperstimulation syndrome with the use of gonadotropin-releasing hormone agonist trigger. Fertil Steril, 2015, 103(4): 870-873.
4.	Meyer L, Murphy LA, Gumer A, et al. Risk factors for a suboptimal response to gonadotropin-releasing hormone agonist trigger during in vitro fertilization cycles. Fertil Steril, 2015, 104(3): 637-642.
5.	Humaidan P, Kol S, Papanikolaou EG, et al. GnRH agonist for triggering of final oocyte maturation: time for a change of practice. Hum Reprod Update, 2011, 17(4): 510-524.
6.	Nelson SM. Prevention and management of ovarian hyperstimulation syndrome. Thromb Res, 2017, 151(Suppl 1): S61-S64.
7.	Mocanu E, Redmond ML, Hennelly B, et al. Odds of ovarian hyperstimulation syndrome (OHSS)-time for reassessment. Hum Fertil (Camb), 2007, 10(3): 175-181.
8.	Vlahos NF, Gregoriou O. Prevention and management of ovarian hyperstimulation syndrome. Ann N Y Acad Sci, 2006, 1092: 247-264.
9.	Engmann L, DiLuigi A, Schmidt D, et al. The use of gonadotropin-releasing hormone (GnRH) agonist to induce oocyte maturation after cotreatment with GnRH antagonist in high-risk patients undergoing in vitro fertilization prevents the risk of ovarian hyperstimulation syndrome: a prospective randomized controlled study. Fertil Steril, 2008, 89(1): 84-91.
10.	Youssef MA, Van der Veen F, Al-Inany HG, et al. Gonadotropin-releasing hormone agonist versus HCG for oocyte triggering in antagonist-assisted reproductive technology. Cochrane Database Syst Rev, 2014, (10): CD008046.
11.	Babayof R, Margalioth EJ, Huleihel M, et al. Serum inhibin A, VEGF and TNFalpha levels after triggering oocyte maturation with GnRH agonist compared with HCG in women with polycystic ovaries undergoing IVF treatment: a prospective randomized trial. Hum Reprod, 2006, 21(5): 1260-1265.
12.	Griesinger G, von Otte S, Schroer A, et al. Elective cryopreservation of all pronuclear oocytes after GnRH agonist triggering of final oocyte maturation in patients at risk of developing OHSS: a prospective, observational proof-of-concept study. Hum Reprod, 2007, 22(5): 1348-1352.
13.	Manzanares MA, Gómez-Palomares JL, Ricciarelli E, et al. Triggering ovulation with gonadotropin-releasing hormone agonist in in vitro fertilization patients with polycystic ovaries does not cause ovarian hyperstimulation syndrome despite very high estradiol levels. Fertil Steril, 2010, 93(4): 1215-1219.
14.	Chen ZJ, Shi Y, Sun Y, et al. Fresh versus frozen embryos for infertility in the polycystic ovary syndrome. N Engl J Med, 2016, 375(6): 523-533.

1. March WA, Moore VM, Willson KJ, et al. The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria. Hum Reprod, 2010, 25(2): 544-551.
2. Chang WY, Knochenhauer ES, Bartolucci AA, et al. Phenotypic spectrum of polycystic ovary syndrome: clinical and biochemical characterization of the three major clinical subgroups. Fertil Steril, 2005, 83(6): 1717-1723.
3. Fatemi HM, Garcia-Velasco J. Avoiding ovarian hyperstimulation syndrome with the use of gonadotropin-releasing hormone agonist trigger. Fertil Steril, 2015, 103(4): 870-873.
4. Meyer L, Murphy LA, Gumer A, et al. Risk factors for a suboptimal response to gonadotropin-releasing hormone agonist trigger during in vitro fertilization cycles. Fertil Steril, 2015, 104(3): 637-642.
5. Humaidan P, Kol S, Papanikolaou EG, et al. GnRH agonist for triggering of final oocyte maturation: time for a change of practice. Hum Reprod Update, 2011, 17(4): 510-524.
6. Nelson SM. Prevention and management of ovarian hyperstimulation syndrome. Thromb Res, 2017, 151(Suppl 1): S61-S64.
7. Mocanu E, Redmond ML, Hennelly B, et al. Odds of ovarian hyperstimulation syndrome (OHSS)-time for reassessment. Hum Fertil (Camb), 2007, 10(3): 175-181.
8. Vlahos NF, Gregoriou O. Prevention and management of ovarian hyperstimulation syndrome. Ann N Y Acad Sci, 2006, 1092: 247-264.
9. Engmann L, DiLuigi A, Schmidt D, et al. The use of gonadotropin-releasing hormone (GnRH) agonist to induce oocyte maturation after cotreatment with GnRH antagonist in high-risk patients undergoing in vitro fertilization prevents the risk of ovarian hyperstimulation syndrome: a prospective randomized controlled study. Fertil Steril, 2008, 89(1): 84-91.
10. Youssef MA, Van der Veen F, Al-Inany HG, et al. Gonadotropin-releasing hormone agonist versus HCG for oocyte triggering in antagonist-assisted reproductive technology. Cochrane Database Syst Rev, 2014, (10): CD008046.
11. Babayof R, Margalioth EJ, Huleihel M, et al. Serum inhibin A, VEGF and TNFalpha levels after triggering oocyte maturation with GnRH agonist compared with HCG in women with polycystic ovaries undergoing IVF treatment: a prospective randomized trial. Hum Reprod, 2006, 21(5): 1260-1265.
12. Griesinger G, von Otte S, Schroer A, et al. Elective cryopreservation of all pronuclear oocytes after GnRH agonist triggering of final oocyte maturation in patients at risk of developing OHSS: a prospective, observational proof-of-concept study. Hum Reprod, 2007, 22(5): 1348-1352.
13. Manzanares MA, Gómez-Palomares JL, Ricciarelli E, et al. Triggering ovulation with gonadotropin-releasing hormone agonist in in vitro fertilization patients with polycystic ovaries does not cause ovarian hyperstimulation syndrome despite very high estradiol levels. Fertil Steril, 2010, 93(4): 1215-1219.
14. Chen ZJ, Shi Y, Sun Y, et al. Fresh versus frozen embryos for infertility in the polycystic ovary syndrome. N Engl J Med, 2016, 375(6): 523-533.

Chinese Journal of Evidence-Based Medicine

Efficacy of different trigger managements on in vitro fertilization and embryo transfer outcome

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