Dual Trigger" in IVF Patients at High Risk of Ovarian Hyper Stimulation Syndrome

Summary

The present study aims to evaluate whether the use of a "dual trigger" can improve IVF outcomes, compared to GnRH agonist (GnRH-a) alone, in patients at high risk of OHSS undergoing a freeze-all cycle. By examining freeze-all cycles with frozen embryo transfer(s) (FET) only, we eliminate the potential confounding issue of inadequate luteal support to the endometrium and focus primarily on the effect of a "dual trigger" on oocyte quality and embryo potential. To our best knowledge, there have been no randomized, controlled trials conducted to address this hypothesis.

Timeline

Start

2019-05-01

Primary completion

2023-12-31

Completion

2023-12-31

Publications

• Background Corbett S, Shmorgun D, Claman P; REPRODUCTIVE ENDOCRINOLOGY INFERTILITY COMMITTEE; SPECIAL CONTRIBUTOR. The prevention of ovarian hyperstimulation syndrome. J Obstet Gynaecol Can. 2014 Nov;36(11):1024-1033. doi: 10.1016/S1701-2163(15)30417-5. English, French.
• Background Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril. 2004 Jan;81(1):19-25. doi: 10.1016/j.fertnstert.2003.10.004.
• Background Ferraretti AP, Gianaroli L, Magli C, Fortini D, Selman HA, Feliciani E. Elective cryopreservation of all pronucleate embryos in women at risk of ovarian hyperstimulation syndrome: efficiency and safety. Hum Reprod. 1999 Jun;14(6):1457-60. doi: 10.1093/humrep/14.6.1457.
• Background Galindo A, Bodri D, Guillen JJ, Colodron M, Vernaeve V, Coll O. Triggering with HCG or GnRH agonist in GnRH antagonist treated oocyte donation cycles: a randomised clinical trial. Gynecol Endocrinol. 2009 Jan;25(1):60-6. doi: 10.1080/09513590802404013.
• Background Griffin D, Benadiva C, Kummer N, Budinetz T, Nulsen J, Engmann L. Dual trigger of oocyte maturation with gonadotropin-releasing hormone agonist and low-dose human chorionic gonadotropin to optimize live birth rates in high responders. Fertil Steril. 2012 Jun;97(6):1316-20. doi: 10.1016/j.fertnstert.2012.03.015. Epub 2012 Apr 3.
• Background Huang CY, Shieh ML, Li HY. The benefit of individualized low-dose hCG support for high responders in GnRHa-triggered IVF/ICSI cycles. J Chin Med Assoc. 2016 Jul;79(7):387-93. doi: 10.1016/j.jcma.2016.02.006. Epub 2016 May 1.
• Background Lin H, Wang W, Li Y, Chen X, Yang D, Zhang Q. Triggering final oocyte maturation with reduced doses of hCG in IVF/ICSI: a prospective, randomized and controlled study. Eur J Obstet Gynecol Reprod Biol. 2011 Nov;159(1):143-7. doi: 10.1016/j.ejogrb.2011.07.009. Epub 2011 Aug 6.
• Background Ludwig M, Doody KJ, Doody KM. Use of recombinant human chorionic gonadotropin in ovulation induction. Fertil Steril. 2003 May;79(5):1051-9. doi: 10.1016/s0015-0282(03)00173-0.
• Background McClure N, Healy DL, Rogers PA, Sullivan J, Beaton L, Haning RV Jr, Connolly DT, Robertson DM. Vascular endothelial growth factor as capillary permeability agent in ovarian hyperstimulation syndrome. Lancet. 1994 Jul 23;344(8917):235-6. doi: 10.1016/s0140-6736(94)93001-5.
• Background Melo M, Busso CE, Bellver J, Alama P, Garrido N, Meseguer M, Pellicer A, Remohi J. GnRH agonist versus recombinant HCG in an oocyte donation programme: a randomized, prospective, controlled, assessor-blind study. Reprod Biomed Online. 2009 Oct;19(4):486-92. doi: 10.1016/j.rbmo.2009.06.001.
• Background Nargund G, Hutchison L, Scaramuzzi R, Campbell S. Low-dose HCG is useful in preventing OHSS in high-risk women without adversely affecting the outcome of IVF cycles. Reprod Biomed Online. 2007 Jun;14(6):682-5. doi: 10.1016/s1472-6483(10)60668-2.
• Background Neulen J, Yan Z, Raczek S, Weindel K, Keck C, Weich HA, Marme D, Breckwoldt M. Human chorionic gonadotropin-dependent expression of vascular endothelial growth factor/vascular permeability factor in human granulosa cells: importance in ovarian hyperstimulation syndrome. J Clin Endocrinol Metab. 1995 Jun;80(6):1967-71. doi: 10.1210/jcem.80.6.7775647.
• Background O'Neill KE, Senapati S, Maina I, Gracia C, Dokras A. GnRH agonist with low-dose hCG (dual trigger) is associated with higher risk of severe ovarian hyperstimulation syndrome compared to GnRH agonist alone. J Assist Reprod Genet. 2016 Sep;33(9):1175-84. doi: 10.1007/s10815-016-0755-8. Epub 2016 Jun 27.
• Background Oktay K, Turkcuoglu I, Rodriguez-Wallberg KA. GnRH agonist trigger for women with breast cancer undergoing fertility preservation by aromatase inhibitor/FSH stimulation. Reprod Biomed Online. 2010 Jun;20(6):783-8. doi: 10.1016/j.rbmo.2010.03.004. Epub 2010 Mar 6.
• Background Orvieto R, Rabinson J, Meltzer S, Zohav E, Anteby E, Homburg R. Substituting HCG with GnRH agonist to trigger final follicular maturation--a retrospective comparison of three different ovarian stimulation protocols. Reprod Biomed Online. 2006 Aug;13(2):198-201. doi: 10.1016/s1472-6483(10)60615-3.
• Background Papanikolaou EG, Pozzobon C, Kolibianakis EM, Camus M, Tournaye H, Fatemi HM, Van Steirteghem A, Devroey P. Incidence and prediction of ovarian hyperstimulation syndrome in women undergoing gonadotropin-releasing hormone antagonist in vitro fertilization cycles. Fertil Steril. 2006 Jan;85(1):112-20. doi: 10.1016/j.fertnstert.2005.07.1292.
• Background Pellicer A, Albert C, Mercader A, Bonilla-Musoles F, Remohi J, Simon C. The pathogenesis of ovarian hyperstimulation syndrome: in vivo studies investigating the role of interleukin-1beta, interleukin-6, and vascular endothelial growth factor. Fertil Steril. 1999 Mar;71(3):482-9. doi: 10.1016/s0015-0282(98)00484-1.
• Background Practice Committee of the American Society for Reproductive Medicine. Electronic address: [email protected]; Practice Committee of the American Society for Reproductive Medicine. Prevention and treatment of moderate and severe ovarian hyperstimulation syndrome: a guideline. Fertil Steril. 2016 Dec;106(7):1634-1647. doi: 10.1016/j.fertnstert.2016.08.048. Epub 2016 Sep 24.
• Background Revelli A, Carosso A, Grassi G, Gennarelli G, Canosa S, Benedetto C. Empty follicle syndrome revisited: definition, incidence, aetiology, early diagnosis and treatment. Reprod Biomed Online. 2017 Aug;35(2):132-138. doi: 10.1016/j.rbmo.2017.04.012. Epub 2017 May 23.
• Background Schmidt DW, Maier DB, Nulsen JC, Benadiva CA. Reducing the dose of human chorionic gonadotropin in high responders does not affect the outcomes of in vitro fertilization. Fertil Steril. 2004 Oct;82(4):841-6. doi: 10.1016/j.fertnstert.2004.03.055.
• Background Shaker AG, Zosmer A, Dean N, Bekir JS, Jacobs HS, Tan SL. Comparison of intravenous albumin and transfer of fresh embryos with cryopreservation of all embryos for subsequent transfer in prevention of ovarian hyperstimulation syndrome. Fertil Steril. 1996 May;65(5):992-6. doi: 10.1016/s0015-0282(16)58275-2.
• Background Shapiro BS, Daneshmand ST, Garner FC, Aguirre M, Hudson C. Comparison of "triggers" using leuprolide acetate alone or in combination with low-dose human chorionic gonadotropin. Fertil Steril. 2011 Jun 30;95(8):2715-7. doi: 10.1016/j.fertnstert.2011.03.109. Epub 2011 May 7.
• Background Youssef MA, Van der Veen F, Al-Inany HG, Mochtar MH, Griesinger G, Nagi Mohesen M, Aboulfoutouh I, van Wely M. Gonadotropin-releasing hormone agonist versus HCG for oocyte triggering in antagonist-assisted reproductive technology. Cochrane Database Syst Rev. 2014 Oct 31;2014(10):CD008046. doi: 10.1002/14651858.CD008046.pub4.
• Background Sismanoglu A, Tekin HI, Erden HF, Ciray NH, Ulug U, Bahceci M. Ovulation triggering with GnRH agonist vs. hCG in the same egg donor population undergoing donor oocyte cycles with GnRH antagonist: a prospective randomized cross-over trial. J Assist Reprod Genet. 2009 May;26(5):251-6. doi: 10.1007/s10815-009-9326-6. Epub 2009 Jul 23.
• Background Werner, M. D., Forman, E. J., Hong, K. H., Franasiak, J. M., Neal, S. A., & Scott, R. T. (2014). Dual trigger with GnRH agonist (GnRHa) and varying doses of hCG increases the blastulation rate amongst high responders. Fertility and Sterility, 102(3), e220
• Background Angelo, D. A., & Nn, A. (2012). Embryo freezing for preventing ovarian hyperstimulation syndrome (Review) SUMMARY OF FINDINGS FOR THE MAIN COMPARISON, (3).
• Background Shaltout, A., Eid, M., & Shohayeb, A. (2006). Does triggering ovulation by 5000 IU of uhCG affect ICSI outcome? Middle East Fertility Society Journal, 11: 99-103.
• Background Gardner DK, Schoolcraft WB. In vitro culture of human blastocyst. In: Janson R, Mortimer D, editors. Towards Reproductive Certainty: Infertility and Genetics Beyond 1999. Carnforth: Parthenon Press; 1999. p. 378-88.

Drugs

Indications