Risk factors for poor oocyte yield and oocyte immaturity after GnRH agonist triggering.

Area of Science:

• Reproductive Endocrinology
• In Vitro Fertilization
• Ovarian Stimulation

Background:

• Gonadotropin-releasing hormone agonist (GnRHa) is increasingly used for ovulation triggering in assisted reproductive technologies.
• Suboptimal responses, including poor oocyte recovery and immaturity, can occur after GnRHa triggering, necessitating identification of risk factors.
• Existing research has explored various factors influencing GnRHa trigger efficacy, but a consensus on predictive markers remains elusive.

Purpose of the Study:

• To identify potential risk factors associated with poor oocyte recuperation rate (ORR) following GnRHa ovulation triggering.
• To investigate risk factors contributing to oocyte immaturity (low oocyte maturation rate, OMR) after GnRHa triggering.
• To provide insights for optimizing ovulation triggering strategies in fertility treatments.

Main Methods:

• A bicentric retrospective cohort study including 1747 patients aged 18-43 undergoing GnRHa triggering (triptorelin 0.2 mg) for ICSI or oocyte cryopreservation.
• ORR defined as retrieved oocytes/follicles >12 mm; OMR defined as mature oocytes/retrieved oocytes.
• Multivariate logistic regression analysis was employed to identify significant risk factors for poor ORR and OMR.

Main Results:

• Lower initial antral follicular count and LH levels 12-h post-triggering were associated with poor ORR.
• Higher Body Mass Index (BMI) and anti-Müllerian hormone (AMH) levels were significantly associated with a higher risk of oocyte immaturity (OMR < 75%).
• Antigonadotrophic pretreatment was found to decrease the risk of oocyte immaturity.

Conclusions:

• Patients with higher BMI and/or low ovarian reserve may benefit from alternative ovulation triggering strategies to avoid poor ORR, balancing against OHSS risk.
• Low 12-h post-triggering LH levels indicate a risk of poor ORR, suggesting consideration of hCG retriggering.
• Identifying these risk factors can help clinicians personalize ovulation triggering protocols for improved outcomes in IVF cycles.