Open AccessGonadotropin-releasing hormone agonist for ovulation trigger – OHSS prevention and use of modified luteal phase support for fresh embryo transfer
Author(s) -
Juan Carlos Castillo,
Thor Haahr,
María Martínez-Moya,
Peter Humaıdan
Publication year - 2020
Publication title -
upsala journal of medical sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.808
H-Index - 41
eISSN - 2000-1967
pISSN - 0300-9734
DOI - 10.1080/03009734.2020.1736696
Subject(s) - luteal phase , ovarian hyperstimulation syndrome , medicine , embryo transfer , ovulation , agonist , ovulation induction , human chorionic gonadotropin , luteinizing hormone , live birth , andrology , endocrinology , hormone , in vitro fertilisation , embryo , pregnancy , biology , receptor , genetics , microbiology and biotechnology
The introduction of gonadotrophin-releasing hormone agonist (GnRHa) trigger greatly impacted modern IVF treatment. Patients at low risk of ovarian hyperstimulation syndrome (OHSS) development, undergoing fresh embryo transfer and GnRHa trigger can be offered a virtually OHSS-free treatment with non-inferior reproductive outcomes by using a modified luteal phase support in terms of small boluses of human chorionic gonadotrophin (hCG), daily recombinant luteinizing hormone LH (rLH) or GnRHa. In the OHSS risk patient, GnRHa trigger can safely be performed, followed by a 'freeze-all' policy with a minimal risk of OHSS development and high live birth rates in the subsequent frozen embryo transfer cycle. Importantly, GnRHa trigger opened the 'black box' of the luteal phase, promoting research in the most optimal steroid levels during the luteal phase. GnRHa trigger allows high-dose gonadotropin stimulation to achieve the optimal number of oocytes and embryos needed to ensure the highest chance of live birth. This review thoroughly discusses how the GnRHa trigger concept adds safety and efficacy to modern IVF in terms of OHSS prevention. Furthermore, the optimal luteal phase management after GnRHa trigger in fresh embryo transfer cycles is discussed.