Basic understanding of gonadotropin-releasing hormone-agonist triggering

Area of Science:

• Reproductive Endocrinology
• In Vitro Fertilization
• Assisted Reproductive Technology

Background:

• Human chorionic gonadotropin (hCG) bolus is the established method for inducing final oocyte maturation and ovulation in assisted reproductive technology (ART).
• Gonadotropin-releasing hormone agonist (GnRH-a) triggering has emerged as a newer alternative in ART cycles.

Purpose of the Study:

• To review the physiologic basis for utilizing GnRH-agonist (GnRH-a) triggering in in vitro fertilization (IVF) cycles.
• To compare the effects of GnRH-a triggering versus hCG triggering on hormonal surges and clinical outcomes.

Main Methods:

• Review of existing literature on hormonal triggers in assisted reproductive technology.
• Discussion of the physiological mechanisms of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) surges induced by hCG and GnRH-a.
• Comparative analysis of safety profiles, focusing on ovarian hyperstimulation syndrome (OHSS).

Main Results:

• GnRH-a triggering may induce a more physiologic LH and FSH surge compared to hCG.
• The shorter duration of the LH surge with GnRH-a is associated with a reduced risk of ovarian hyperstimulation syndrome (OHSS) in GnRH antagonist IVF cycles.
• The impact of GnRH-a triggering on oocyte and embryo quality requires further investigation.

Conclusions:

• GnRH-a triggering presents a viable alternative to hCG for ovulation induction in IVF.
• GnRH-a triggering demonstrates a favorable safety profile, particularly in preventing OHSS in specific IVF protocols.
• Further research is needed to fully elucidate the effects of GnRH-a on gamete and embryo development.