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Fertility Preservation Through Oocyte Vitrification: Clinical and Laboratory Perspectives
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Suboptimal response to GnRH agonist trigger: causes and practical management.

Peter Humaidan1, Shahar Kol2

  • 1The Fertility Clinic, Skive Regional Hospital, Skive, Denmark. Faculty of Health, Aarhus University, Aarhus, Denmark. Faculty of Health, University of Southern Denmark, Odense, Denmark.

Current Opinion in Obstetrics & Gynecology
|April 26, 2021
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Summary

Understanding suboptimal responses to gonadotropin-releasing hormone agonist (GnRHa) triggers in in vitro fertilization is crucial. Identifying risk factors like prior downregulation or low LH levels can help prevent failed oocyte retrieval.

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Area of Science:

  • Reproductive Endocrinology
  • In Vitro Fertilization (IVF)

Background:

  • Gonadotropin-releasing hormone agonists (GnRHa) are widely used for ovulation induction in IVF.
  • A GnRH agonist trigger aims to induce an adequate luteinizing hormone (LH) surge for final oocyte maturation.

Purpose of the Study:

  • To review and outline potential causes of a suboptimal response to GnRH agonist triggers in IVF cycles.
  • To enhance clinical awareness of factors that may lead to failed oocyte maturation.

Main Methods:

  • Literature review of factors associated with suboptimal GnRH agonist trigger response.
  • Analysis of risk factors impacting LH surge induction and oocyte maturation.

Main Results:

  • Identified risk factors include prolonged hormonal contraceptive use, prior GnRHa-induced pituitary downregulation, hypogonadotropic hypogonadism, patient error, product degradation, receptor polymorphisms, low baseline LH, low serum LH on trigger day, and low BMI.
  • An LH urine test 12 hours post-trigger can confirm adequate LH surge induction.

Conclusions:

  • While GnRHa triggers usually elicit effective LH and FSH surges for mature oocytes, awareness of predisposing conditions is vital.
  • Recognizing and managing these risk factors can help prevent failed oocyte retrieval in IVF.