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In vitro fertilization (IVF) is a form of assisted reproductive technology where an egg is fertilized with sperm in a controlled laboratory environment before transferring the resulting embryo into the uterus. This process is designed to help individuals and couples experiencing difficulties conceiving.
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The Trigger in IVF Cycles: Molecular Pathways and Clinical Implications.

Giorgio Maria Baldini1, Domenico Baldini2, Dario Lot2

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Optimizing oocyte maturation triggers in assisted reproductive technology (ART) involves balancing efficacy and safety. While human chorionic gonadotropin (hCG) is common, gonadotropin-releasing hormone agonists (GnRHa) and newer agents like kisspeptin offer alternatives to reduce ovarian hyperstimulation syndrome (OHSS) risk.

Keywords:
GnRH agonistdouble triggerdual triggerhCG triggerin vitro fertilization (IVF)kisspeptinoocyte maturation

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Area of Science:

  • Reproductive Endocrinology
  • Assisted Reproductive Technology (ART)
  • Ovarian Physiology

Background:

  • Final oocyte maturation is critical for ART success.
  • Current triggers like human chorionic gonadotropin (hCG) carry risks, notably ovarian hyperstimulation syndrome (OHSS).
  • Alternative agents and protocols are being explored to optimize outcomes and safety.

Purpose of the Study:

  • To review and compare different final oocyte maturation trigger strategies in ART.
  • To evaluate their impact on oocyte competence, embryo development, and pregnancy rates.
  • To assess the risk of OHSS associated with various triggering agents and protocols.

Main Methods:

  • Review of existing literature on oocyte maturation triggers, including hCG, GnRHa, dual/double trigger protocols, and kisspeptin.
  • Analysis of studies investigating optimization of trigger timing based on patient and follicular parameters.
  • Comparison of outcomes such as MII rate, fertilization, embryo development, and OHSS incidence.

Main Results:

  • GnRHa-based strategies and dual triggers show promise in improving specific outcomes and reducing OHSS risk in selected patients.
  • hCG remains widely used but is associated with a significant OHSS risk.
  • Kisspeptin is a promising but largely experimental option, with limited clinical data.

Conclusions:

  • Individualized trigger selection based on patient characteristics, ovarian response, and OHSS risk is crucial.
  • GnRHa-based strategies may offer benefits over hCG in certain subgroups, but evidence is inconsistent.
  • Further well-designed randomized trials are needed to confirm the efficacy of novel triggers like kisspeptin and optimize their use.