GnRH agonist trigger VS HCG trigger for final oocyte maturation in GnRH antagonist protocol ICSI cycles: A Randomized Controlled Study

Abstract

Ovarian hyperstimulation syndrome (OHSS) is a complication of fertility treatment, which depends on pharmacological ovarian stimulation to increase the number of oocytes and therefore embryos available during assisted reproductive technology (ART) (Thalakottoor et al., 2015). Severe OHSS is a potentially life-threatening, grave complication and occurs in about 2%-6% of IVF cycles resulting in hospitalization in about 1.9% of cases resulting in significant morbidity and rarely, mortality due to thromboembolic disease, adult respiratory distress syndrome, and hepatorenal failure (Krishna D et al., 2016). Of the various strategies used for the prevention of OHSS, the most effective strategy to date is the use of Gonadotropin Releasing Hormone agonist (GnRHa) as trigger in antagonist cycles, which markedly reduces its occurrence (Humaidan P et al., 2014). The aim of the work was to compare the effectiveness of GnRH agonist trigger versus HCG trigger to reduce OHSS and also its effects on oocyte maturation, fertilization, embryo quality and clinical pregnancy rate. The study was performed on a total of 200 women who underwent ICSI at Ain Shams University hospitals and other private centers. The included patients aged from 18 to 40 years with primary or secondary infertility with BMI between 18 and 40 Kg/m2 and baseline FSH and LH below 12 IU/L. While women with ovarian endometriosis, ovarian cyst before induction, any endocrine abnormalities or AMH ≥ 10 ng/ml were excluded from the study.