Co-administration of GnRH-agonist and hCG, for final oocyte maturation (double trigger), in patients with low proportion of mature oocytes. (11th November 2014)

• Record Type: Journal Article
• Authors: Zilberberg, Eran; Haas, Jigal; Dar, Shir; Kedem, Alon; Machtinger, Ronit; Orvieto, Raoul
• Is Part Of: Gynecological endocrinology. Volume 31:Number 2(2015:Feb.)
• Page Start: 145
• Page End: 147
• Publication Date: 2014-11-11
• Subjects: Final oocyte maturation -- GnRH-agonist -- GnRH-antagonist -- hCG -- IVF outcome -- oocytes retrieval; Endocrine gynecology -- Periodicals; Generative organs, Female -- Diseases -- Periodicals; 618.1
• DOI: 10.3109/09513590.2014.978850
• Languages: English
• ISSNs: 0951-3590

Abstract

Abstract: Objective : Human chorionic gonadotropin (hCG) is usually used at the end of controlled ovarian hyperstimulation (COH), as a surrogate LH surge, to induce final oocyte maturation and resumption of meiosis. Recently, the co-administration of GnRH agonist and hCG for final oocyte maturation – 40 and 34 h prior to OPU, respectively (double trigger) was suggested to improve IVF outcome in patient with genuine empty follicle syndrome. In the present study, we aim to evaluate whether the double trigger might improve the proportions of metaphase-II (MII) oocytes in patients with low proportion of mature oocytes (<66%) per number oocytes retrieved. Patients and methods : We compared the stimulation characteristics of 12 IVF cycles, which include the cycle with the double trigger to the same patients' previous IVF attempt, triggered with hCG-only. Results : Patients who received the double trigger (study group) had a significantly higher number of mature oocytes – MII (6.5 versus 3.6 p < 0.008), number of embryos transferred (2.4 versus 1.1 p < 0.03), a significantly higher proportions of MII oocytes per number of oocytes retrieved (69.7% versus 47.1% p < 0.03) and a higher number of top quality embryos (3.1 versus 1 p < 0.02), as compared to their previous control cycles (hCG-only trigger). Six pregnancies were recorded in the study group and none in the control group. Conclusions : Co-administration of GnRH-agonist and hCG for final oocyte maturation, 40 and 34 h prior to OPU, respectively (double trigger) improves IVF outcome in patients with high proportion of immature oocytes. Chinese abstract: 目的 ：人绒毛膜促性腺激素（Human Chorionic Gonadotropin，hCG）通常作为一种替代的LH峰应用于控制性超促排卵（Controlled Ovarian Hyperstimulation，COH）的最后阶段，以诱导卵子的最终成熟及启动卵母细胞的减数分裂。近来，有研究表明在取卵术前34小时和40小时各行一次GnRH激动剂联合hCG"双扳机"（Double Trigger）可以改善真性空卵泡综合征（Genuine Empty Follicle Syndrome，GEFS）患者的IVF结局。本研究中，我们旨在评估"双扳机"是否可以提高低卵子成熟率（＜66%）的患者每获卵周期成熟卵（Metaphase-II，MII）的比例。对象和方法 ：我们比较了12名患者前次仅用hCG扳机周期和本次采用"双扳机"IVF周期中刺激相关参数。结果 ：与前次对照周期（仅用hCG扳机）相比，双扳机组（实验组）的成熟卵子数即MII卵数（6.5 vs 3.6， p ＜0.008）、移植胚胎数（2.4 vs 1.1， p ＜0.03），每获卵周期MII卵的比例（69.7% vs 47.1%， p ＜0.03）均显著升高。双扳机组的优质胚胎数（3.1 vs 1， p ＜0.02）也高于对照组。实验组中6例获得妊娠，而对照组中无一例妊娠。 结论 ：取卵术前34小时和40小时各行一次GnRH激动剂联合hCG"双扳机"可改善低成熟卵率患者的IVF结局。