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Cycles triggered with GnRH agonist: exploring low-dose HCG for luteal support
J C Castillo1, M Dolz, E Bienvenido
1Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Hospital Clínico Universitario de Valencia, Blasco Ibañez Avenue 17, Valencia 46010, Spain. jccastillo@fiv-valencia.es
Reproductive Biomedicine Online
|February 2, 2010
Summary
This study found that using a gonadotropin-releasing hormone (GnRH) agonist for ovulation triggering and low-dose human chorionic gonadotropin (HCG) for luteal support in IVF cycles is safe and effective. It achieves normal pregnancy outcomes without increasing the risk of ovarian hyperstimulation syndrome (OHSS).
Area of Science:
- Reproductive Endocrinology and Infertility
Background:
- Ovarian hyperstimulation syndrome (OHSS) is a significant risk in assisted reproductive technology cycles.
- Optimizing luteal support is crucial for successful IVF/intracytoplasmic sperm injection (ICSI) outcomes, especially in OHSS-risk patients.
Purpose of the Study:
- To evaluate the efficacy and safety of luteal support with human chorionic gonadotropin (HCG) after ovulation triggering with a gonadotropin-releasing hormone (GnRH) agonist.
- To assess pregnancy rates and the incidence of OHSS in patients at risk undergoing IVF/ICSI antagonist cycles.
Main Methods:
- A prospective study involving 192 OHSS-risk patients using a GnRH antagonist protocol.
- Ovulation was triggered with a single dose of GnRH agonist (leuproreline).
- Luteal support was provided with three doses of HCG (1000 IU, 500 IU, or 250 IU) every third day.
Main Results:
- An overall pregnancy rate of 51.8% and a clinical pregnancy rate of 43.4% were observed.
- The incidence of moderate OHSS was 4.2% (8 cases) and severe OHSS was 3.6% (7 cases).
- Late-onset severe OHSS, related to pregnancy, accounted for 85.7% of severe cases.
Conclusions:
- A single dose of GnRH agonist for ovulation triggering combined with low-dose HCG for luteal support is effective for achieving pregnancy in IVF/ICSI cycles.
- This strategy appears to maintain normal pregnancy outcomes while mitigating the risk of OHSS in high-risk patients.
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