GnRH agonist-only trigger, compared to dual trigger, reduces oocyte retrieval rate in high responders without affecting cumulative live birth rate

Front Endocrinol (Lausanne). 2024 Aug 20:15:1461317. doi: 10.3389/fendo.2024.1461317. eCollection 2024.

Abstract

Introduction: This study compared, in high responders undergoing IVF treatment, GnRH agonist-only trigger and dual trigger on oocyte retrieval rate and cumulative live birth rate (LBR). The aim was to determine if the GnRH agonist-only triggers had provided outcomes comparable to dual trigger, while minimizing the risk of ovarian hyperstimulation syndrome (OHSS).

Materials and methods: A retrospective, matched case-control study was conducted at Taichung Veterans General Hospital, Taiwan, including women who underwent IVF/ICSI between January 1, 2014, and December 31, 2022. Inclusion criteria were: GnRH antagonist protocol and estrogen level >3,000 pg/ml on trigger day. Exclusion criteria were: immune/metabolic diseases, donated oocytes, and mixed stimulation cycles. Propensity score matching was applied to balance age, AMH level, and oocyte number between the GnRH agonist-only and dual trigger groups. Outcomes were analyzed for patients who had complete treatment cycles, focusing on oocyte retrieval rate and cumulative LBR.

Results: We analyzed 116 cycles in the agonist-only group, and 232 cycles in the dual trigger group. No inter-group difference was found in their age, BMI, and AMH levels. The dual trigger group had a higher oocyte retrieval rate (93% vs. 80%; p <0.05), while fertilization rates, blastocyst formation rates, and cumulative LBR were comparable. Notably, no OHSS cases had been reported in the GnRH agonist-only group, compared with 7 cases in the dual trigger group.

Conclusion: GnRH agonist-only triggers resulted in a lower oocyte retrieval rate compared to dual triggers but did not significantly affect cumulative LBR in high responders. This approach effectively reduces OHSS risk without compromising pregnancy outcomes, making it a preferable option in freeze-all strategies, despite a longer oocyte pick-up duration and a medium cost. GnRH agonist-only trigger, however, may not be suitable for fresh embryo transfers or patients with low serum LH levels on trigger day.

Keywords: GnRH agonist; dual trigger; in vitro fertilization (IVF); live birth; oocyte retrieval rate.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Birth Rate*
  • Case-Control Studies
  • Female
  • Fertility Agents, Female / administration & dosage
  • Fertility Agents, Female / therapeutic use
  • Fertilization in Vitro* / methods
  • Gonadotropin-Releasing Hormone* / agonists
  • Gonadotropin-Releasing Hormone* / antagonists & inhibitors
  • Humans
  • Live Birth / epidemiology
  • Oocyte Retrieval* / methods
  • Ovarian Hyperstimulation Syndrome* / epidemiology
  • Ovarian Hyperstimulation Syndrome* / prevention & control
  • Ovulation Induction* / methods
  • Pregnancy
  • Pregnancy Rate
  • Retrospective Studies
  • Sperm Injections, Intracytoplasmic / methods
  • Taiwan / epidemiology

Substances

  • Gonadotropin-Releasing Hormone
  • Fertility Agents, Female

Grants and funding

The author(s) declare that no financial support was received for the research, authorship, and/or publication of this article.