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Ovarian hyperstimulation syndrome prevention by gonadotropin-releasing hormone agonist triggering of final oocyte maturation in a gonadotropin-releasing hormone antagonist protocol in combination with a "freeze-all" strategy: a prospective multicentric study.
Fertil Steril. 2011 May; 95(6):2029-33, 2033.e1.FS

Abstract

OBJECTIVE

To prospectively study ovarian hyperstimulation syndrome (OHSS) incidence and cumulative live birth rate in a cohort of patients at risk of OHSS undergoing ovarian stimulation in a GnRH antagonist protocol and receiving a GnRH agonist triggering followed by cryopreservation of all two pronuclei (2PN)-stage zygotes by two methods, vitrification or slow-cooling, for later ET.

DESIGN

Prospective, clinical cohort study.

SETTING

Five IVF centers in Germany; time frame: June 2008 to June 2010.

PATIENT(S)

Fifty-one female patients undergoing IVF considered at risk of developing severe OHSS (≥20 follicles≥11 mm and/or E2 level≥4,000 pg/mL) after ovarian stimulation in a GnRH antagonist protocol.

INTERVENTION(S)

Triptorelin (0.2 mg SC) for triggering final oocyte maturation. All 2PN-stage zygotes were cryopreserved by vitrification or slow-cooling for later repetitive frozen-thawed ET.

MAIN OUTCOME MEASURE(S)

Severe OHSS incidence and cumulative live birth rate per patient.

RESULT(S)

Of 51 patients, 1 patient (2%, 95% confidence [CI] 0.3%-10.3%) had zero oocyte retrieved, 1 patient did not undergo frozen-thawed ET, and 1 patient had no surviving oocyte after thawing. Thus, 48 patients underwent at least one frozen-thawed ET. The cumulative live birth rate was 37.3% (19/51, 95% CI 25.3%-51.0%). The live birth rate per first frozen-thawed ET was 5.9% (1/17, 95% CI 10.0%-27.0%) and 19.4% (6/31, 95% CI 9.2%-36.3%) in the slow-cooling and vitrification group, respectively (difference: 13.5%, 95% CI of the difference: -9.9%-31.1%). Three cases of OHSS II (3/51, 5.9%, 95% CI 2.0%-15.9%) and one early-onset case of OHSS III (1/51, 2%, 95% CI 0.3%-10.3%) occurred.

CONCLUSION(S)

Agonist triggering with cryopreservation is efficacious and safe, although a single case of a severe early-onset OHSS occurred.

Authors+Show Affiliations

Department of Obstetrics and Gynecology, University Clinic of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany. griesing@uni-luebeck.deNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

21371705

Citation

Griesinger, Georg, et al. "Ovarian Hyperstimulation Syndrome Prevention By Gonadotropin-releasing Hormone Agonist Triggering of Final Oocyte Maturation in a Gonadotropin-releasing Hormone Antagonist Protocol in Combination With a "freeze-all" Strategy: a Prospective Multicentric Study." Fertility and Sterility, vol. 95, no. 6, 2011, pp. 2029-33, 2033.e1.
Griesinger G, Schultz L, Bauer T, et al. Ovarian hyperstimulation syndrome prevention by gonadotropin-releasing hormone agonist triggering of final oocyte maturation in a gonadotropin-releasing hormone antagonist protocol in combination with a "freeze-all" strategy: a prospective multicentric study. Fertil Steril. 2011;95(6):2029-33, 2033.e1.
Griesinger, G., Schultz, L., Bauer, T., Broessner, A., Frambach, T., & Kissler, S. (2011). Ovarian hyperstimulation syndrome prevention by gonadotropin-releasing hormone agonist triggering of final oocyte maturation in a gonadotropin-releasing hormone antagonist protocol in combination with a "freeze-all" strategy: a prospective multicentric study. Fertility and Sterility, 95(6), 2029-33, e1. https://doi.org/10.1016/j.fertnstert.2011.01.163
Griesinger G, et al. Ovarian Hyperstimulation Syndrome Prevention By Gonadotropin-releasing Hormone Agonist Triggering of Final Oocyte Maturation in a Gonadotropin-releasing Hormone Antagonist Protocol in Combination With a "freeze-all" Strategy: a Prospective Multicentric Study. Fertil Steril. 2011;95(6):2029-33, 2033.e1. PubMed PMID: 21371705.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Ovarian hyperstimulation syndrome prevention by gonadotropin-releasing hormone agonist triggering of final oocyte maturation in a gonadotropin-releasing hormone antagonist protocol in combination with a "freeze-all" strategy: a prospective multicentric study. AU - Griesinger,Georg, AU - Schultz,Laura, AU - Bauer,Thomas, AU - Broessner,Anke, AU - Frambach,Thorsten, AU - Kissler,Stefan, Y1 - 2011/03/02/ PY - 2010/11/22/received PY - 2011/01/25/revised PY - 2011/01/26/accepted PY - 2011/3/5/entrez PY - 2011/3/5/pubmed PY - 2011/6/22/medline SP - 2029-33, 2033.e1 JF - Fertility and sterility JO - Fertil Steril VL - 95 IS - 6 N2 - OBJECTIVE: To prospectively study ovarian hyperstimulation syndrome (OHSS) incidence and cumulative live birth rate in a cohort of patients at risk of OHSS undergoing ovarian stimulation in a GnRH antagonist protocol and receiving a GnRH agonist triggering followed by cryopreservation of all two pronuclei (2PN)-stage zygotes by two methods, vitrification or slow-cooling, for later ET. DESIGN: Prospective, clinical cohort study. SETTING: Five IVF centers in Germany; time frame: June 2008 to June 2010. PATIENT(S): Fifty-one female patients undergoing IVF considered at risk of developing severe OHSS (≥20 follicles≥11 mm and/or E2 level≥4,000 pg/mL) after ovarian stimulation in a GnRH antagonist protocol. INTERVENTION(S): Triptorelin (0.2 mg SC) for triggering final oocyte maturation. All 2PN-stage zygotes were cryopreserved by vitrification or slow-cooling for later repetitive frozen-thawed ET. MAIN OUTCOME MEASURE(S): Severe OHSS incidence and cumulative live birth rate per patient. RESULT(S): Of 51 patients, 1 patient (2%, 95% confidence [CI] 0.3%-10.3%) had zero oocyte retrieved, 1 patient did not undergo frozen-thawed ET, and 1 patient had no surviving oocyte after thawing. Thus, 48 patients underwent at least one frozen-thawed ET. The cumulative live birth rate was 37.3% (19/51, 95% CI 25.3%-51.0%). The live birth rate per first frozen-thawed ET was 5.9% (1/17, 95% CI 10.0%-27.0%) and 19.4% (6/31, 95% CI 9.2%-36.3%) in the slow-cooling and vitrification group, respectively (difference: 13.5%, 95% CI of the difference: -9.9%-31.1%). Three cases of OHSS II (3/51, 5.9%, 95% CI 2.0%-15.9%) and one early-onset case of OHSS III (1/51, 2%, 95% CI 0.3%-10.3%) occurred. CONCLUSION(S): Agonist triggering with cryopreservation is efficacious and safe, although a single case of a severe early-onset OHSS occurred. SN - 1556-5653 UR - https://www.unboundmedicine.com/medline/citation/21371705/Ovarian_hyperstimulation_syndrome_prevention_by_gonadotropin_releasing_hormone_agonist_triggering_of_final_oocyte_maturation_in_a_gonadotropin_releasing_hormone_antagonist_protocol_in_combination_with_a_"freeze_all"_strategy:_a_prospective_multicentric_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0015-0282(11)00242-1 DB - PRIME DP - Unbound Medicine ER -