Suboptimal response to GnRH-agonist trigger during oocyte cryopreservation: a case series

Area of Science:

• Reproductive Endocrinology
• Oncofertility
• Assisted Reproductive Technologies

Background:

• Random-start, controlled ovarian stimulation (COS) offers expedited fertility preservation for cancer patients.
• Luteal-phase start (LPS) protocols initiate COS during the luteal phase, but are less studied than conventional protocols.
• Evidence on trigger medication efficacy in LPS protocols is limited, particularly for GnRH agonist (GnRH-a) triggers.

Observation:

• This case series evaluated two cancer patients undergoing oocyte cryopreservation using an LPS protocol with a GnRH-a trigger.
• Both patients exhibited an inadequate response to the GnRH-a trigger, evidenced by luteinizing hormone (LH) and progesterone levels.
• A rescue dose of human chorionic gonadotropin (hCG) was required for both patients.

Findings:

• Patients undergoing LPS-COS may experience suboptimal responses to GnRH-a triggers.
• Elevated luteal-phase progesterone may downregulate GnRH receptors, potentially causing this diminished response.
• The efficacy of GnRH-a triggers in LPS protocols remains uncertain.

Implications:

• This study highlights a potential risk associated with GnRH-a triggers in LPS protocols for oocyte cryopreservation.
• Management strategies to mitigate suboptimal responses are suggested.
• Further research is crucial to establish optimal trigger medication protocols for LPS-COS.