Optimization of in vitro fertilization programs by replacing an ovulation trigger


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Abstract

Objective. To optimize in vitro fertilization programs in patients at high risk for ovarian hyperstimulation syndrome (OHSS) through replacement of an ovulation trigger and simulation of the luteal phase. Subjects and methods. The investigation enrolled 258patients aged 20 to 39 years at high risk for OHSS. The patients were divided into three groups according to the injected ovulation trigger: 1) gonadotropin-releasing hormone (GnRH) agonist (GnRH-a) 0.2 mg (n = 91); 2) GnRH-a 0.2 mg with simultaneous injection of human chorionic gonadotropin (hCG) 1500I U(n = 82); 3) hCG 10,000 IU(n = 85). Micronizedprogesterone 600mg/day and estradiol valerate 4 mg/day were used for luteal phase support in Groups 1 and 2. In Group 1, hCG was additionally injected in a dose of 1500 IU for luteal phase support on the day of transvaginal puncture (TVP). In Group 3, micronized progesterone was administered in a dose of 600 mg/day for luteal phase support. Results. Comparison of Groups 1 and 3 revealed a statistically significant difference in the incidence of mild OHSS (< 0.001); that of Groups 1 and 2 and that of Groups 2 and 3 disclosed no statistically significant difference (p > 0.05). Thus, mild OHSS developed in 11 (12.1%) patients in the group where the trigger was replaced by GnRH agonist, in 16 (19.5%) in the double trigger (GnRH-a + hCG) group, and in 27 (31.8%) in the hCG group. Moderate OHSS developed in 7 (7.7%) patients in Group 1, in 6 (9.8%) in Group 2, and in 8 (9.4%) in Group 3; comparison of the incidence of moderate OHSS revealed no statistically significant differences in the examined groups (p > 0.05). No case of severe OHSS was recorded in the GnRH-a group. In the GnRH-a + hCG group, the incidence of severe OHSS was 1.2% (n = 1), which was statistically significantly lower than that in the hCG group [10.6% (n = 9)] (р >0.05, р <0.001, р = 0.011). The rate of conception after embryo transfer was 45.2, 42.2, and 45.6% in the GnRH-a, GnRH-a + hCG, and hCG groups, respectively (p > 0.05, ANOVA). There were no statistically significant differences in the rates of clinical pregnancy, pregnancy termination, and progressive pregnancy. Conclusion. Replacement of the ovulation trigger by GnRH-a in the patients at high risk for OHSS is effective in reducing its risk and has no negative impact on conception rates when the luteal phase is modified.

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About the authors

B. A Martazanova

Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: bellamart88@mail.ru
graduate student

N. G Mishieva

Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: nondoc555@mail.ru
MD, Senior researcher of 1st gynecology department

L. A Levkov

Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: l_levkov@oparina4.ru
MD, PhD, Head of Department

A. M Gracheva

Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: Alusha.M.Petruk@yandex.ru
graduate student

Kh. A Bogatyreva

Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: Eva-90-B@yandex.ru
graduate student

S. M Eapen

I.M. Sechenov First Moscow State Medical University

Email: dr.snehaeapen@gmail.com
graduate student

V. S Lapina

Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: vslapina89@Gmail.ru
graduate student

A. N Abubakirov

Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: nondoc555@yahoo.com
PhD, Head of 1st gynecology department

References

  1. Корнеева И.Е., Калинина Е.А., Сароян Т.Т., Смольникова В.Ю., Серебренникова К.Г., Пырегов А.В., Сухих Г.Т. Федеральные клинические рекомендации. Диагностика и лечение синдрома гиперстимуляции яичников. М.: Российское общество акушеров-гинекологов; 2013.
  2. Braat D.D., Schutte J.M., Bernardus R.E., Mooij T.M., van Leeuwen F.E. Maternal death related to IVF in the Netherlands 1984-2008. Hum. Reprod. 2010; 25(7): 1782-6.
  3. Acevedo B., Gomez-Palomares J.L., Ricciarelli E., Hernández E.R. Triggering ovulation with gonadotropin-releasing hormone agonists does not compromise embryo implantation rates. Fertil. Steril. 2006; 86(6): 1682-7.
  4. Youssef M.A., Van der Veen F., Al-Inany H.G., Griesinger G., Mochtar M.H., Aboulfoutouh I. et al. Gonadotropin-releasing hormone agonist versus HCG for oocyte triggering in antagonist assisted reproductive technology cycles. Cochrane Database Syst. Rev. 2011; (1): CD008046.
  5. Carizza C., Abdelmassih V., Abdelmassih S., Ravizzini P., Salgueiro L., Salgueiro P.T. et al. Cabergoline reduces the early onset of ovarian hyperstimulation syndrome: a prospective randomized study. Reprod. Biomed. Online. 2008; 17(6): 751-5.
  6. Delvigne A., Rozenberg S. Epidemiology and prevention of ovarian hyperstimulation syndrome (OHSS): a review. Hum. Reprod. Update. 2002; 8(6): 559-77.
  7. Semba S., Moriya T., Youssef E.M., Sasano H. An autopsy case of ovarian hyperstimulation syndrome with massive pulmonary edema and pleural effusion. Pathol. Int. 2000; 50(7): 549-52.
  8. Delvigne A., Rozenberg S. A qualitative systematic review of coasting, a procedure to avoid ovarian hyperstimulation syndrome in IVF patients. Hum. Reprod. Update. 2002; 8(3): 291-6.
  9. Vlahos N.F., Gregoriou O. Prevention and management of ovarian hyperstimulation syndrome. Ann. N. Y. Acad. Sci. 2006; 1092: 247-64.
  10. Papanikolaou E.G., Tournaye H., Verpoest W., Camus M., Vernaeve V., Van Steirteghem A., Devroey P. Early and late ovarian hyperstimulation syndrome: early pregnancy outcome and profile. Hum. Reprod. 2005; 20(3): 636-41.
  11. Корнеева И.Е., Иванова А.В., Баркалина Н.В. Синдром гиперстимуляции яичников: профилактика, диагностика, лечение (обзор литературы). Проблемы репродукции. 2004; 10(1): 43-50.
  12. Itskovitz J., Boldes R., Barlev A., Erlik Y., Kahana L., Brandes J.M. The induction of LH surge and oocyte maturation by GnRH analogue (buserelin) in women undergoing ovarian stimulation for in vitro fertilisation. Gynecol. Endocrinol. 1988; 2(Suppl. 2):165.
  13. Fauser B.C., de Jong D., Olivennes F., Wramsby H., Tay C., Itskovitz-Eldor J., van Hooren H.G. Endocrine profiles after triggering of final oocyte maturation with GnRH agonist after cotreatment with the GnRH antagonist ganirelix during ovarian hyperstimulation for in vitro fertilization. J. Clin. Endocrinol. Metab. 2002; 87(2): 709-15.
  14. Kol S. Luteolysis induced by a gonadotropin-releasing hormone agonist is the key to prevention of ovarian hyperstimulation syndrome. Fertil. Steril. 2004; 81(1): 1-5.
  15. Youssef M.A., Van der Veen F., Al-Inany H.G., Mochtar M.H., Griesinger G., NagiMohesen M. et al. Gonadotropin-releasing hormone agonist versus HCG for oocyte triggering in antagonist-assisted reproductive technology. Cochrane Database Syst. Rev. 2014; (10): CD008046.
  16. Lee T.H., Liu C.H., Huang C.C., Wu Y.L., Shih Y.T., Ho H.N. et al. Serum anti-Müllerian hormone and estradiol levels as predictors of ovarian hyperstimulation syndrome in assisted reproduction technology cycles. Hum. Reprod. 2008; 23(1): 160-7.
  17. Kwee J., Schats R., McDonnell J., Themmen A., de Jong F., Lambalk C. Evaluation of anti-Müllerian hormone as a test for the prediction of ovarian reserve. Fertil. Steril. 2008; 90(3): 737-43.
  18. Gardner D.K., Schoolcraft W.B. Culture and transfer of human blastocysts. Curr. Opin. Obstet. Gynecol. 1999; 11(3): 307-11.
  19. Humaidan P., Bungum L., Bungum M., Yding Andersen C. Rescue of corpus luteum function with periovulatory HCG supplementation in IVF/ICSI GnRH antagonist cycles in which ovulation was triggered with a GnRH agonist: a pilot study. Reprod. Biomed. Online. 2006; 13(2): 173-8.
  20. Humaidan P., Polyzos N.P., Alsbjerg B., Erb K., Mikkelsen A.L., Elbaek H.O. et al. GnRHa trigger and individualized luteal phase hCG support according to ovarian response to stimulation: two prospective randomized controlled multi-centre studies in IVF patients. Hum. Reprod. 2013; 28(9): 2511-21.
  21. Bodri D., Guillén J.J., Galindo A., Mataró D., Pujol A., Coll O. Triggering with human chorionic gonadotropin or a gonadotropin-releasing hormone agonist in gonadotropin-releasing hormone antagonist-treated oocyte donor cycles: findings of a large retrospective cohort study. Fertil. Steril. 2009; 91(2): 365-71.
  22. Shapiro B.S., Daneshmand S.T., Garner F.C., Aguirre M., Hudson C. Comparison of “triggers” using leuprolide acetate alone or in combination with low-dose human chorionic gonadotropin. Fertil. Steril. 2011; 95(8): 2715-17.
  23. Griffin D., Feinn R., Engmann L., Nulsen J., Budinetz T., Benadiva C. Dual trigger with gonadotropin-releasing hormone agonist and standard dose human chorionic gonadotropin to improve oocyte maturity rates. Fertil. Steril. 2014; 102(2): 405-9.
  24. Engmann L., DiLuigi A., Schmidt D., Nulsen J., Maier D., Benadiva C. The use of gonadotropin-releasing hormone (GnRH) agonist to induce oocyte maturation after cotreatment withGnRH antagonist in high-risk patients undergoing in vitro fertilization prevents the risk of ovarian hyperstimulation syndrome: a prospective randomized controlled study. Fertil. Steril. 2008; 89(1): 84-91.
  25. Seyhan A., Ata B., Polat M., Son W.Y., Yarali H., Dahan M.H. Severe early ovarian hyperstimulation syndrome following GnRH agonist trigger with the addition of 1500 IU hCG. Hum. Reprod. 2013; 28(9): 2522-8.
  26. Atkinson P., Koch J., Ledger W.L. GnRH agonist trigger and a freeze-all strategy to prevent ovarian hyperstimulation syndrome: a retrospective study of OHSS risk and pregnancy rates. Aust. N. Z. J. Obstet. Gynaecol. 2014; 54(6): 581-5.

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