Individual luteolysis post GnRH-agonist-trigger in GnRH-antagonist protocols

Area of Science:

• Reproductive Endocrinology
• In Vitro Fertilization (IVF)

Background:

• GnRH-agonist trigger is widely used in IVF/ICSI for final oocyte maturation, reducing ovarian hyperstimulation syndrome (OHSS) risk.
• GnRH-agonist trigger typically causes significant luteolysis, requiring robust luteal phase support (hCG or high-dose progesterone).
• Recent evidence suggests luteolysis may be incomplete after GnRH-agonist trigger, challenging standard luteal phase support protocols.

Purpose of the Study:

• To evaluate the degree of luteolysis in high-responder patients undergoing IVF/ICSI following GnRH-agonist trigger.
• To assess the individual variability of luteolysis even in high-responder patients.
• To advocate for individualized luteal phase support strategies.

Main Methods:

• Case-series study evaluating luteolysis.
• Measurement of estradiol (E2) and progesterone (P4) levels 48 hours post-oocyte-pickup (OPU).
• Focus on high-responder patients receiving GnRH-agonist for final oocyte maturation.

Main Results:

• Luteolysis following GnRH-agonist trigger is highly individual-specific, even among high-responder patients with similar oocyte yields.
• Estradiol and P4 levels 48 hours post-OPU demonstrated significant inter-patient variability in luteolysis.
• Standard luteal phase support may not be universally optimal due to variable luteolysis.

Conclusions:

• Individualized luteal phase support is crucial after GnRH-agonist trigger.
• Developing a "luteal coasting" strategy based on the severity of luteolysis is proposed.
• This approach aims to avoid unnecessary hCG administration and associated OHSS risks.