Infertility and at High Risk of OHSS
Conditions
Keywords
Ovarian Hyperstimulation Syndrome, Luteinizing Hormone, Polycystic Ovarian Syndrome, Ovarian Yield, Ovarian Maturity
Brief summary
Gonadotropin releasing hormone (GnRH) agonist is sufficient for triggering final oocyte maturation in GnRH antagonist protocol and can significantly reduce incidence of ovarian hyperstimulation syndrome (OHSS) in high-risk patients. However, lower oocyte yield was reported in patients with lower luteinizing hormone (LH) level post trigger with single injection of GnRH agonist, which might be related to the shorter duration and lower amount of LH induced by GnRH agonist. Our aim is to study repeated injection of GnRH agonist for preventing OHSS and maintaining clinical outcome in high risk patients who receive controlled ovarian stimulation in GnRH antagonist protocol.
Detailed description
This was a prospective cohort study of all women attending the Center for Reproductive Medicine, Department of Gynecology and Obstetrics, Nanfang Hospital, affiliated with Southern Medical University for in vitro fertilization and/or intracytoplasmic sperm injection . Women at high risk of OHSS who received IVF and/or intracytoplasmic sperm injection (ICSI) treatment with a flexible GnRH antagonist protocol were recruited to participate in this study. All patients underwent standard ovarian stimulation protocol with gonadotropins, standard individualized adjustment of medication dose, and standard egg retrieval procedure. Patients were triggered with a single bolus of 0.2 mg triptorelin at night and had second injection of 0.2 mg triptorelin 12 hours later when the criteria for administration of the ovulation trigger were met.
Interventions
DRUGtriptorelin
0.2 mg, ih, at night and 0.2 mg, ih, 12 hours later when at least one of the following criteria was reached: (i) serum E2 ≥3500 pg/ml, (ii) ≥18 follicles measuring ≥11 mm.
Sponsors
National Natural Science Foundation of China
Comprehensive Strategic Cooperation Project of Guangdong Province and Chinese Academy of Science
Guangzhou Science and Technology Program key projects
National Key Basic Research Development Plan of China
Chenshiling
Study design
Allocation
NON_RANDOMIZED
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
FEMALE
Age
No minimum to 40 Years
Healthy volunteers
No
Inclusion criteria
* patients with polycystic ovarian syndrome * patients with polycystic ovarian morphology on ultrasound * patients who previously experienced an ovarian stimulation cycle, with a high response to gonadotrophins
Exclusion criteria
* patients undergoing coasting * patients with past ovarian surgery
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Oocyte maturity | 24 hours post oocyte retrieval day | Oocyte maturity was defined as the ratio of metaphase II (MII) oocytes to the number of collected oocytes in the patients undergoing with ICSI. |
| clinical pregnancy rate per transfer cycle | 1month post embryo transfer | — |
| numbers of patients having OHSS | 2 weeks post trigger with repeated GnRHa | — |
| oocyte yield | oocyte retrieval day (34 to 38 hours post the first trigger with GnRHa) | Oocyte yield was defined as the ratio of the total number of collected oocytes to the number of follicles measuring ≥10 mm on the day of oocyte retrieval. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| serum luteinizing hormone level 12 hours post first trigger | 12 hours post trigger with the first injection of GnRHa | — |
| serum luteinizing hormone level 24 hours post first trigger | 24 hours post the first injection of GnRHa | — |
| fertilization rate | 48 hours post IVF/ICSI | Fertilization rate was defined as the ratio of normal fertilized oocytes (2PNs) to the number of oocytes used for fertilization (i.e. the denominator in IVF in calculating fertilization rate is all oocytes recovered, but in ICSI it is calculated using only the number of MII oocytes). |
| implantation rate | 1 month post embryo transfer | — |
Countries
China
Contacts
Primary ContactShi-Ling Chen, M.D., Ph.D.
Outcome results
None listed