Department of Gynaecology, Hammersmith Hospital, Imperial College NHS Trust, London, UK.
Department of Surgery and Cancer, Imperial College London, London, UK.
Hum Fertil (Camb). 2021 Dec;24(5):360-366. doi: 10.1080/14647273.2019.1671614. Epub 2019 Oct 1.
The aim of this study was to compare clinical and laboratory outcomes between GnRHa, dual and HCG triggers in altruistic oocyte donation cycles. Normal or high responders were given either gonadotropin releasing hormone agonist (GnRHa) or a dual trigger of GnRHa and a low dose of human chorionic gonadotropin (HCG). Low responders were given HCG trigger. In 333 cycles, 232 (69.7%) received GnRHa trigger, 59 (17.7%) received dual trigger and 42 (12.6%) had HCG trigger. The total number of mature oocytes retrieved and cryopreserved were significantly higher in the GnRHa and dual trigger groups, compared to the HCG group ( < 0.001). However, the ovarian hyperstimulation syndrome (OHSS) rate was significantly higher in the dual trigger group ( = 5 (8.5%)), compared to the GnRH agonist ( = 1 (0.4%)) and HCG groups ( = 0 (0%)) ( = 0.001). GnRHa trigger maximises mature oocyte yields in oocyte donors suspected of normal and high response but offers a significant reduction in OHSS risk compared to dual trigger. As such, dual trigger should not be used in oocyte donation. HCG trigger can also be used with a very low risk of OHSS at low risk of OHSS in carefully selected donors where GnRHa is unlikely to be effective.
本研究旨在比较 GnRHa、双重和 HCG 扳机在利他性卵子捐赠周期中的临床和实验室结局。给予正常或高反应者促性腺激素释放激素激动剂(GnRHa)或 GnRHa 和低剂量人绒毛膜促性腺激素(HCG)的双重扳机。低反应者给予 HCG 扳机。在 333 个周期中,232 个(69.7%)接受了 GnRHa 扳机,59 个(17.7%)接受了双重扳机,42 个(12.6%)接受了 HCG 扳机。GnRHa 和双重扳机组的成熟卵母细胞总数和冷冻保存数量明显高于 HCG 组(<0.001)。然而,双重扳机组的卵巢过度刺激综合征(OHSS)发生率明显高于 GnRHa 激动剂组(=1(0.4%))和 HCG 组(=0(0%))(=0.001)。GnRHa 扳机可最大限度地增加疑似正常和高反应的卵子供体的成熟卵母细胞产量,但与双重扳机相比,OHSS 风险显著降低。因此,不应该在卵子捐赠中使用双重扳机。HCG 扳机也可用于 OHSS 风险极低的情况下,在 GnRH 不太可能有效的情况下,在经过精心挑选的低 OHSS 风险供体中使用。