Federal State Budget Institution (FSBI) National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov Ministry of Healthcare of the Russian Federation, Moscow, Russia.
Front Endocrinol (Lausanne). 2022 Aug 15;13:834627. doi: 10.3389/fendo.2022.834627. eCollection 2022.
The major limitations associated with gonadotropin-releasing hormone agonist (GnRHa) triggering are inferior clinical outcomes in fresh embryo transfer cycles caused by luteal phase insufficiency following the GnRHa triggering. We included 153 high-risk patients in this study. In group I, the patients received gonadotropin-releasing hormone agonist (GnRHa) trigger + 1,500 IU human chorionic gonadotropin (hCG) support on the oocyte pick-up (OPU) day; in group II, the patients had a dual trigger (GnRHa + 1,500 IU hCG); and in group III (control), 10,000 IU hCG trigger was prescribed for the final oocyte maturation. The levels of LH, estradiol, and progesterone were evaluated in serum on the stimulation starting day, day 6 of stimulation, on the day of the trigger administration, OPU day, days 3 and 5 post-OPU, and day 14 post-ET, as well as in follicular fluid. Progesterone concentration was significantly lower in group I on OPU+5 compared to the hCG group (I vs. III, р = 0.0065). Progesterone levels were significantly lower in group II in serum on OPU+5 compared to groups I and III (I vs. II, = 0.0068; II vs. III, = 1.76 × 10). The progesterone levels were significantly higher in follicular fluid in group III compared to the study groups (I vs. III, = 0.002; II vs. III, = 0.009). However, no significant differences in clinical outcomes were found between the groups. Then, we divided all women into pregnant and non-pregnant groups and found that estradiol ( = 0.00009) and progesterone ( = 0.000036 on the day of the pregnancy test were significantly higher in the pregnant women group. Also, progesterone on OPU day was significantly higher in the non-pregnant group ( = 0.033). Two cases of moderate ovarian hyperstimulation syndrome (OHSS) late-onset occurred in group I (3.5%, 2/56), no case of moderate/severe OHSS late-onset in group II, and three cases of moderate late-onset in group III (5.7%, 3/53). The low-dose hCG supplementation improves the luteal phase insufficiency after GnRHa triggering, which is confirmed by the comparable pregnancy rates in fresh transfer cycles between the groups. However, low-dose hCG carries a similar risk of OHSS as the full dose of hCG in high-responder patients.
促性腺激素释放激素激动剂 (GnRHa) 触发的主要限制是 GnRHa 触发后黄体期不足导致新鲜胚胎移植周期的临床结局较差。我们将 153 名高危患者纳入本研究。在 I 组中，患者在取卵日（OPU）接受促性腺激素释放激素激动剂（GnRHa）触发+1500IU 人绒毛膜促性腺激素（hCG）支持；在 II 组中，患者进行双重触发（GnRHa+1500IU hCG）；在 III 组（对照组）中，规定在最后一个卵子成熟时给予 10000IU hCG 触发。在开始刺激的第 1 天、第 6 天、触发管理的当天、OPU 日、OPU 后第 3 天和第 5 天以及 ET 后第 14 天，评估血清中的 LH、雌二醇和孕酮水平，以及卵泡液。与 hCG 组相比，I 组在 OPU+5 时的孕酮水平显着降低（I 组与 III 组比较，p=0.0065）。与 I 组和 III 组相比，II 组在 OPU+5 时的血清孕酮水平显着降低（I 组与 II 组比较，p=0.0068；II 组与 III 组比较，p=1.76×10）。与研究组相比，III 组卵泡液中的孕酮水平显着升高（I 组与 III 组比较，p=0.002；II 组与 III 组比较，p=0.009）。然而，各组之间的临床结局没有发现显著差异。然后，我们将所有女性分为妊娠组和非妊娠组，发现妊娠组雌二醇（p=0.00009）和孕酮（妊娠试验当天 p=0.000036）显着升高。此外，非妊娠组 OPU 日的孕酮水平显着升高（p=0.033）。I 组发生 2 例中度卵巢过度刺激综合征（OHSS）迟发性（3.5%，2/56），II 组无中度/重度 OHSS 迟发性病例，III 组发生 3 例中度迟发性病例（5.7%，3/53）。GnRHa 触发后，低剂量 hCG 补充可改善黄体期不足，这从各组新鲜移植周期的可比妊娠率得到证实。然而，低剂量 hCG 在高反应患者中与全剂量 hCG 一样有发生 OHSS 的风险。
