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The use of gonadotropin-releasing hormone (GnRH) agonist to induce oocyte maturation after cotreatment with GnRH antagonist in high-risk patients undergoing in vitro fertilization prevents the risk of ovarian hyperstimulation syndrome: a prospective randomized controlled study.
Fertil Steril. 2008 Jan; 89(1):84-91.FS

Abstract

OBJECTIVE

To determine whether there are any differences in the incidence of ovarian hyperstimulation syndrome (OHSS) and implantation rates in high-risk patients undergoing IVF using a protocol consisting of GnRH agonist trigger after cotreatment with GnRH antagonist or hCG trigger after dual pituitary suppression protocol.

DESIGN

Prospective randomized controlled trial.

SETTING

University-based tertiary fertility center.

PATIENT(S)

Sixty-six patients under 40 years of age with polycystic ovarian syndrome, polycystic ovarian morphology, or previous high response undergoing IVF.

INTERVENTION(S)

Patients were randomized to an ovarian stimulation protocol consisting of either GnRH agonist trigger after cotreatment with GnRH antagonist (study group) or hCG trigger after dual pituitary suppression with a GnRH agonist (control group). Both groups received luteal phase and early pregnancy supplementation with IM progesterone (P), and patients in the study group also received E(2) patches and their doses were adjusted according to the serum levels.

MAIN OUTCOME MEASURE(S)

Incidence of OHSS and implantation rate.

RESULT(S)

None of the patients in the study group developed any form of OHSS compared with 31% (10/32) of the patients in the control group. There were no significant differences in the implantation (22/61 [36.0%] vs. 20/64 [31.0%]), clinical pregnancy (17/30 [56.7%] vs. 15/29 [51.7%]), and ongoing pregnancy rates (16/30 [53.3%] vs. 14/29 [48.3%]) between the study and control groups, respectively.

CONCLUSION(S)

The use of a protocol consisting of GnRH agonist trigger after GnRH antagonist cotreatment combined with adequate luteal phase and early pregnancy E(2) and P supplementation reduces the risk of OHSS in high-risk patients undergoing IVF without affecting implantation rate.

Authors+Show Affiliations

Center for Advanced Reproductive Services, Department of Obstetrics and Gynecology, Dowling South Building, University of Connecticut Health Center, Farmington, Connecticut 06030-6224, USA. lengmann@uchc.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17462639

Citation

Engmann, Lawrence, et al. "The Use of Gonadotropin-releasing Hormone (GnRH) Agonist to Induce Oocyte Maturation After Cotreatment With GnRH Antagonist in High-risk Patients Undergoing in Vitro Fertilization Prevents the Risk of Ovarian Hyperstimulation Syndrome: a Prospective Randomized Controlled Study." Fertility and Sterility, vol. 89, no. 1, 2008, pp. 84-91.
Engmann L, DiLuigi A, Schmidt D, et al. The use of gonadotropin-releasing hormone (GnRH) agonist to induce oocyte maturation after cotreatment with GnRH 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.
Engmann, L., DiLuigi, A., Schmidt, D., Nulsen, J., Maier, D., & Benadiva, C. (2008). The use of gonadotropin-releasing hormone (GnRH) agonist to induce oocyte maturation after cotreatment with GnRH antagonist in high-risk patients undergoing in vitro fertilization prevents the risk of ovarian hyperstimulation syndrome: a prospective randomized controlled study. Fertility and Sterility, 89(1), 84-91.
Engmann L, et al. The Use of Gonadotropin-releasing Hormone (GnRH) Agonist to Induce Oocyte Maturation After Cotreatment With GnRH 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. PubMed PMID: 17462639.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The use of gonadotropin-releasing hormone (GnRH) agonist to induce oocyte maturation after cotreatment with GnRH antagonist in high-risk patients undergoing in vitro fertilization prevents the risk of ovarian hyperstimulation syndrome: a prospective randomized controlled study. AU - Engmann,Lawrence, AU - DiLuigi,Andrea, AU - Schmidt,David, AU - Nulsen,John, AU - Maier,Donald, AU - Benadiva,Claudio, Y1 - 2007/04/26/ PY - 2006/11/21/received PY - 2007/02/01/revised PY - 2007/02/01/accepted PY - 2007/4/28/pubmed PY - 2008/1/25/medline PY - 2007/4/28/entrez SP - 84 EP - 91 JF - Fertility and sterility JO - Fertil Steril VL - 89 IS - 1 N2 - OBJECTIVE: To determine whether there are any differences in the incidence of ovarian hyperstimulation syndrome (OHSS) and implantation rates in high-risk patients undergoing IVF using a protocol consisting of GnRH agonist trigger after cotreatment with GnRH antagonist or hCG trigger after dual pituitary suppression protocol. DESIGN: Prospective randomized controlled trial. SETTING: University-based tertiary fertility center. PATIENT(S): Sixty-six patients under 40 years of age with polycystic ovarian syndrome, polycystic ovarian morphology, or previous high response undergoing IVF. INTERVENTION(S): Patients were randomized to an ovarian stimulation protocol consisting of either GnRH agonist trigger after cotreatment with GnRH antagonist (study group) or hCG trigger after dual pituitary suppression with a GnRH agonist (control group). Both groups received luteal phase and early pregnancy supplementation with IM progesterone (P), and patients in the study group also received E(2) patches and their doses were adjusted according to the serum levels. MAIN OUTCOME MEASURE(S): Incidence of OHSS and implantation rate. RESULT(S): None of the patients in the study group developed any form of OHSS compared with 31% (10/32) of the patients in the control group. There were no significant differences in the implantation (22/61 [36.0%] vs. 20/64 [31.0%]), clinical pregnancy (17/30 [56.7%] vs. 15/29 [51.7%]), and ongoing pregnancy rates (16/30 [53.3%] vs. 14/29 [48.3%]) between the study and control groups, respectively. CONCLUSION(S): The use of a protocol consisting of GnRH agonist trigger after GnRH antagonist cotreatment combined with adequate luteal phase and early pregnancy E(2) and P supplementation reduces the risk of OHSS in high-risk patients undergoing IVF without affecting implantation rate. SN - 1556-5653 UR - https://www.unboundmedicine.com/medline/citation/17462639/The_use_of_gonadotropin_releasing_hormone__GnRH__agonist_to_induce_oocyte_maturation_after_cotreatment_with_GnRH_antagonist_in_high_risk_patients_undergoing_in_vitro_fertilization_prevents_the_risk_of_ovarian_hyperstimulation_syndrome:_a_prospective_randomized_controlled_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0015-0282(07)00338-X DB - PRIME DP - Unbound Medicine ER -