COMPARATIVE ANALYSIS OF THE EFFECTIVENESS OF AN ASSISTED REPRODUCTIVE TECHNOLOGY PROGRAM DEPENDING ON AN OVULATION TRIGGER

Objective. To evaluate the effect of the type of an ovulation trigger on the clinical and embryological indicators of the effectiveness of IVF/ICSI programs in patients with a normal ovarian response to superovulation stimulation. Subjects and methods. The investigation enrolled 250 patients who were divided into 2 groups according to the injected ovulation trigger: 1) 125patients who received human chorionic gonadotropin (hCG); 2) 125patients who took a gonadotropin-releasing hormone agonist (GnRH-A). The luteal phase was supported by micronized progesterone at a dose of 600 mg/day in Groups 1 and 2. In Group 2, for luteal phase support, the investigators additionally injected once hCG at a dose of 1,500 IU on the day of transvaginal ovarian drilling (TOD) and estradiol valerate (Progynova, 4 mg/day) on the following day after TOD. Results. There were statistically significant differences in the incidence of mild ovarian hyperstimulation syndrome (OHSS) in Groups 1 and 2 (p < 0.02). Mild OHSS developed in 9 (6.5%) and 22 (16.9%) patients in the GnRH-A replacement and hCG groups, respectively. Comparison of the frequency of moderate OHSS revealed no statistically signif icant differences in the examined groups: 5.4% (n = 7) in Group 1 and 4.3% (n = 6) in Group 2. In Group 1, two patients developed severe OHSS and required hospital treatment. No case of severe OHSS was recorded in the GnRH-A group. Trigger ovulation replacement did not significantly affect the number of obtained follicles and oocytes in patients of both groups. At the same time, the number of mature MII cells was significantly higher in Group 2 patients. There were no statistically significant differences in clinical pregnancy, spontaneous abortion, and birth rates between the groups. Conclusions. The use of GnRH-A as an ovulation trigger in the GnRH antagonist protocols enables the pregnancy rate to be achieved when modifying the luteal phase at the same frequency as in the use of hCG. Moreover, the rate of moderate or severe OHSS reduced to a minimum

gonadotropin-releasing hormone agonist, assisted reproductive technology, ovulation trigger replacement, ovarian hyperstimulation syndrome, pregnancy rate