Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-76fb5796d-9pm4c Total loading time: 0 Render date: 2024-04-25T08:28:35.110Z Has data issue: false hasContentIssue false

Chapter 27 - The Use of GnRH Agonists to Trigger Final Oocyte Maturation during Controlled Ovarian Stimulation

from Section 6 - Procedures before, during, and after Ovarian Stimulation

Published online by Cambridge University Press:  14 April 2022

By
Anastasia Salameh ,
Sara Faour  and
Johnny Awwad
Edited by
Mohamed Aboulghar  and
Botros Rizk
Mohamed Aboulghar
Affiliation:
University of Cairo IVF Centre
Botros Rizk
Affiliation:
University of South Alabama
Get access

Summary

Gonadotropin-releasing hormone (GnRH) is secreted from the medial basal hypothalamus and controls pituitary function via the hypothalamic tuberoinfundibular system [1]. Follicle-stimulating hormone (FSH) and luteinizing hormone (LH) are synthesized and secreted by the anterior pituitary gland in response to GnRH pulse activity. Physiological modulation of GnRH pulse amplitude and frequency determines the fine interplay between various gonadotropin players during the menstrual cycle [2;3].

Type
Chapter
Information
Ovarian Stimulation , pp. 282 - 289
Publisher: Cambridge University Press
Print publication year: 2022

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Balasubramanian, R, Dwyer, A, Seminara, SB, et al. Human GnRH deficiency: a unique disease model to unravel the ontogeny of GnRH neurons. Neuroendocrinology 2010;92:81–99.CrossRefGoogle ScholarPubMed
Belchetz, PE, Plant, TM, Nakai, Y, et al. Hypophysial responses to continuous and intermittent delivery of hypothalamic gonadotropin-releasing hormone. Science 1978;202:631–633.Google Scholar
Wetsel, WC, Valenca, MM, Merchenthaler, I, et al. Intrinsic pulsatile secretory activity of immortalized luteinizing hormone-releasing hormone-secreting neurons. Proc Natl Acad Sci U S A 1992;89:4149–4153.Google Scholar
Richards, JS. Genetics of ovulation. Semin Reprod Med 2007;25(4):235–242.CrossRefGoogle ScholarPubMed
Duncan, WC. The human corpus luteum: remodeling during luteolysis and maternal recognition of pregnancy. Rev Reprod 2000;5:12–17.CrossRefGoogle ScholarPubMed
Itskovitz, J, Boldes, R, Levron, J, et al. Induction of preovulatory luteinizing hormone surge and prevention of ovarian hyperstimulation syndrome by gonadotropin-releasing hormone agonist. Fertil Steril 1991;56:213–220.Google Scholar
Segal, S, Casper, RF. Gonadotropin-releasing hormone agonist versus human chorionic gonadotropin for triggering follicular maturation in in vitro fertilization. Fertil Steril 1992;57(6):1254–1258.CrossRefGoogle ScholarPubMed
Aboulghar, MA, Mansour, RT. Ovarian hyperstimulation syndrome: classifications and critical analysis of preventive measures. Hum Reprod Update 2003;9(3):275–289.Google Scholar
Macklon, NS, Stouffer, RL, Giudice, LC, et al. The science behind 25 years of ovarian stimulation for in vitro fertilization. Endocr Rev 2006;27(2):170–207.CrossRefGoogle ScholarPubMed
Engmann, L, Claudio, B, Humaidan, P. GnRH agonist trigger for the induction of oocyte maturation in GnRH antagonist IVF cycles: a SWOT analysis. Reprod Biomed Online 2016;32(3):274–285.Google Scholar
Chandrasekher, YA, Hutchison, JS, Zelinski-Wooten, MB, et al. Initiation of periovulatory events in primate follicles using recombinant and native human luteinizing hormone to mimic the midcycle gonadotropin surge. J Clin Endocrinol Metab 1994;79(1):298–306.Google Scholar
Chandrasekher, YA, Brenner, RM, Molskness, TA, et al. Titrating luteinizing hormone surge requirements for ovulatory changes in primate follicles. II. Progesterone receptor expression in luteinizing granulosa cells. J Clin Endocrinol Metab 1991;73(3):584–589.Google Scholar
Gonen, Y, Balakier, H, Powell, W, et al. Use of gonadotropin-releasing hormone agonist to trigger follicular maturation for in vitro fertilization. J Clin Endocrinol Metab 1990;71(4):918–922.Google Scholar
Oktay, K, Türkçüoğlu, I, Rodriguez-Wallberg, KA. GnRH agonist trigger for women with breast cancer undergoing fertility preservation by aromatase inhibitor/FSH stimulation. Reprod Biomed Online 2010;20(6):783–788.CrossRefGoogle ScholarPubMed
Andersen, CY, Leonardsen, L, Ulloa-Aguirre, A, et al. FSH-induced resumption of meiosis in mouse oocytes: effect of different isoforms. Mol Hum Reprod 1999;5(8):726–731.CrossRefGoogle Scholar
Fraser, HM. Regulation of the ovarian follicular vasculature. Reprod Biol Endocrinol 2006;4:18Google Scholar
Molskness, TA, Stouffer, RL, Burry, KA, et al. Circulating levels of total angiopoietin-2 and the soluble Tie-2 receptor in women during ovarian stimulation and early gestation. Fertil Steril 2006;86:1531–1533.Google Scholar
Cerrillo, M, Rodriguez, S, Mayoral, M, et al. Differential regulation of VEGF after final oocyte maturation with GnRH agonist versus hCG: a rationale for OHSS reduction. Fertil Steril 2009;91:1526–1528.CrossRefGoogle ScholarPubMed
Bodri, D, Sunkara, SK, Coomarasamy, A. Gonadotropin releasing hormone agonists versus antagonists for controlled ovarian hyperstimulation in oocyte donors: a systematic review and meta-analysis. Fertil Steril 2011;95:164–169.Google Scholar
Engmann, L, DiLuigi, A, Schmidt, D, et al. The use of gonadotropin-releasing hormone (GnRH) agonist to induce oocyte maturation after cotreatment with GnRH antagonist in high-risk patients undergoing in vitro fertilization prevents the risk of ovarian hyperstimulation syndrome: a prospective randomized controlled study. Fertil Steril 2008;89:84–91.Google Scholar
Lewit, N, Kol, S, Manor, D, et al. Comparison of gonadotrophin-releasing hormone analogues and human chorionic gonadotrophin for the induction of ovulation and prevention of ovarian hyperstimulation syndrome: a case-control study. Hum Reprod 1996;11(7):1399–1402.CrossRefGoogle ScholarPubMed
Fatemi, HM, Garcia-Velasco, J. Avoiding ovarian hyperstimulation syndrome with the use of gonadotropin-releasing hormone agonist trigger. Fertil Steril 2015;103(4):870–873.Google Scholar
Mourad, S, Brown, J, Farquhar, C. Interventions for the prevention of OHSS in ART cycles: an overview of Cochrane reviews. Cochrane Database Syst Rev 2017;1:CD012103.Google Scholar
Gurbuz, AS, Gode, F, Ozcimen, N, et al. Gonadotrophin-releasing hormone agonist trigger and freeze-all strategy does not prevent severe ovarian hyperstimulation syndrome: a report of three cases. Reprod Biomed Online 2014;29(5):541–544.Google Scholar
Parneix, I, Emperaire, JC, Ruffie, A, et al. Comparison of different protocols of ovulation induction, by GnRH agonists and chorionic gonadotropin. Gynecol Obstet Fertil 2001;29(2):100–105.Google Scholar
Pabuccu, EG, Pabuccu, R, Caglar, GS, et al. Different gonadotropin releasing hormone agonist doses for the final oocyte maturation in high-responder patients undergoing in vitro fertilization/intra-cytoplasmic sperm injection. J Hum Reprod Sci 2015;8(1):25–29.Google Scholar
Vuong, TN, Ho, MT, Ha, TD, et al. Gonadotropin-releasing hormone agonist trigger in oocyte donors co-treated with a gonadotropin-releasing hormone antagonist: a dose-finding study. Fertil Steril 2016;105(2):356–363.Google Scholar
Lanzone, A, Fulghesu, AM, Apa, R, et al. LH surge induction by GnRH agonist at the time of ovulation. Gynecol Endocrinol 1989;3(3):213–220.Google Scholar
Awwad, JT, Hannoun, AB, Khalil, A, et al. Induction of final follicle maturation with a gonadotropin-releasing hormone agonist in women at risk of ovarian hyperstimulation syndrome undergoing gonadotropin stimulation and intrauterine insemination: proof-of-concept study. Clin Exp Obstet Gynecol 2012;39(4):436–439.Google Scholar
Humaidan, P, Westergaard, LG, Mikkelsen, AL, et al. Levels of the epidermal growth factor-like peptide amphiregulin in follicular fluid reflect the mode of triggering ovulation: a comparison between gonadotrophin-releasing hormone agonist and urinary human chorionic gonadotrophin. Fertil Steril 2011;95(6):2034–2038.CrossRefGoogle ScholarPubMed
Humaidan, P, Ejdrup Bredkjaer, H, Bungum, L, et al. GnRH agonist (buserelin) or hCG for ovulation induction in GnRH antagonist IVF/ICSI cycles: a prospective randomized study. Hum Reprod 2005;20(5):1213–1220.Google Scholar
Shapiro, BS, Daneshmand, ST, Garner, FC, et al. Gonadotropin-releasing hormone agonist combined with a reduced dose of human chorionic gonadotropin for final oocyte maturation in fresh autologous cycles of in vitro fertilization. Fertil Steril 2008;90(1):231–233.CrossRefGoogle ScholarPubMed
Griesinger, G, Diedrich, K, Devroey, P, et al. GnRH agonist for triggering final oocyte maturation in the GnRH antagonist ovarian hyperstimulation protocol: a systematic review and meta-analysis. Hum Reprod Update 2005;12(2):159–168.Google Scholar
Krishna, D, Dhoble, S, Praneesh, G, et al. Gonadotropin-releasing hormone agonist trigger is a better alternative than human chorionic gonadotropin in PCOS undergoing IVF cycles for an OHSS Free Clinic: a randomized control trial. J Hum Reprod Sci 2016;9(3):164–172.CrossRefGoogle Scholar
Asada, Y, Itoi, F, Honnma, H, et al. Failure of GnRH agonist-triggered oocyte maturation: its cause and management. J Assist Reprod Genet 2013;30(4):581–585.Google Scholar
Kummer, NE, Feinn, RS, Griffin, DW, et al. Predicting successful induction of oocyte maturation after gonadotropin-releasing hormone agonist (GnRHa) trigger. Hum Reprod 2012;28(1):152–159.Google Scholar
Chen, SL, Ye, DS, Chen, X, et al. Circulating luteinizing hormone level after triggering oocyte maturation with GnRH agonist may predict oocyte yield in flexible GnRH antagonist protocol. Hum Reprod 2012;27(5):1351–1356.CrossRefGoogle ScholarPubMed
Meyer, L, Murphy, LA, Gumer, A, et al. Risk factors for a suboptimal response to gonadotropin-releasing hormone agonist trigger during in vitro fertilization cycles. Fertil Steril 2015;104(3):637–642.Google Scholar
Nevo, O, Eldar-Geva, T, Kol, S, et al. Lower levels of inhibin A and pro-alpha C during the luteal phase after triggering oocyte maturation with a gonadotropin-releasing hormone agonist versus human chorionic gonadotropin. Fertil Steril 2003;79(5):1123–1128.Google Scholar
Tesarik, J, Hazout, A, Mendoza, C. Luteinizing hormone affects uterine receptivity independently of ovarian function. Reprod Biomed Online 2003;7(1):59–64.Google Scholar
Kolibianakis, EM, Schultze-Mosgau, A, Schroer, A, et al. A lower ongoing pregnancy rate can be expected when GnRH agonist is used for triggering final oocyte maturation instead of HCG in patients undergoing IVF with GnRH antagonists. Hum Reprod 2005;20(10):2887–2892.Google Scholar
Bermejo, A, Cerrillo, M, Ruiz-Alonso, M, et al. Impact of final oocyte maturation using gonadotropin-releasing hormone agonist triggering and different luteal support protocols on endometrial gene expression. Fertil Steril 2014;101(1):138.e3–146.e3.CrossRefGoogle ScholarPubMed
Engmann, L, Siano, L, Schmidt, D, et al. GnRH agonist to induce oocyte maturation during IVF in patients at high risk of OHSS. Reprod Biomed Online 2006;13(5):639–644.CrossRefGoogle ScholarPubMed
Imbar, T, Kol, S, Lossos, F, et al. Reproductive outcome of fresh or frozen–thawed embryo transfer is similar in high-risk patients for ovarian hyperstimulation syndrome using GnRH agonist for final oocyte maturation and intensive luteal support. Hum Reprod 2012;27(3):753–759.Google Scholar
Iliodromiti, S, Blockeel, C, Tremellen, KP, et al. Consistent high clinical pregnancy rates and low ovarian hyperstimulation syndrome rates in high-risk patients after GnRH agonist triggering and modified luteal support: a retrospective multicentre study. Hum Reprod 2013;28(9):2529–2536.Google Scholar
Humaidan, P. Luteal phase rescue in high-risk OHSS patients by GnRHa triggering in combination with low-dose HCG: a pilot study. Reprod Biomed Online 2009;18(5):630–634.Google Scholar
Humaidan, P, Bredkjær, HE, Westergaard, LG, et al. 1,500 IU human chorionic gonadotropin administered at oocyte retrieval rescues the luteal phase when gonadotropin-releasing hormone agonist is used for ovulation induction: a prospective, randomized, controlled study. Fertil Steril 2010;93(3):847–854.CrossRefGoogle Scholar
Humaidan, P, Polyzos, NP, Alsbjerg, B, et al. GnRHa trigger and individualized luteal phase hCG support according to ovarian response to stimulation: two prospective randomized controlled multi-centre studies in IVF patients. Hum Reprod 2013;28(9):2511–2521.Google Scholar
Shapiro, BS, Daneshmand, ST, Garner, FC, et al. Comparison of “triggers” using leuprolide acetate alone or in combination with low-dose human chorionic gonadotropin. Fertil Steril 2011;95(8):2715–2717.Google Scholar
Christopoulos, G, Vlismas, A, Carby, A, et al. GnRH agonist trigger with intensive luteal phase support vs. human chorionic gonadotropin trigger in high responders: an observational study reporting pregnancy outcomes and incidence of ovarian hyperstimulation syndrome. Hum Fertil 2016;19(3):199–206.Google Scholar
Radesic, B, Tremellen, K. Oocyte maturation employing a GnRH agonist in combination with low-dose hCG luteal rescue minimizes the severity of ovarian hyperstimulation syndrome while maintaining excellent pregnancy rates. Hum Reprod 2011;26(12):3437–3442.Google Scholar
Seyhan, A, Ata, B, Polat, M, et al. Severe early ovarian hyperstimulation syndrome following GnRH agonist trigger with the addition of 1500 IU hCG. Hum Reprod 2013;28(9):2522–2528.Google Scholar
Youssef, MA, Van der Veen, F, Al‐Inany, HG, et al. Gonadotropin‐releasing hormone agonist versus HCG for oocyte triggering in antagonist assisted reproductive technology cycles. Cochrane Database of Syst. Rev 2011;1:CD008046.Google Scholar
Youssef, MA, Van der Veen, F, Al-Inany, HG, et al. The updated Cochrane review 2014 on GnRH agonist trigger: an indispensable piece of information for the clinician. Reprod Biomed Online 2016;32(2):259–260.Google Scholar
Lin, MH, Wu, FS, Lee, RK, et al. Dual trigger with combination of gonadotropin-releasing hormone agonist and human chorionic gonadotropin significantly improves the live-birth rate for normal responders in GnRH-antagonist cycles. Fertil Steril 2013;100(5):1296–1302CrossRefGoogle ScholarPubMed
O’Neill, KE, Senapati, S, Maina, I, et al. 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;33(9):1175–1184.Google Scholar
Pirard, C, Loumaye, E, Laurent, P, et al. Contribution to more patient-friendly ART treatment: efficacy of continuous low-dose GnRH agonist as the only luteal support – results of a prospective, randomized, comparative study. Int J Endocrinol 2015;2015:727569.Google Scholar
Bar-Hava, I, Mizrachi, Y, Karfunkel-Doron, D, et al. Intranasal gonadotropin-releasing hormone agonist (GnRHa) for luteal-phase support following GnRHa triggering, a novel approach to avoid ovarian hyperstimulation syndrome in high responders. Fertil Steril 2016;106(2):330–333.CrossRefGoogle ScholarPubMed
Kol, S, Breyzman, T, Segal, L, Humaidan, P. ‘Luteal coasting’ after GnRH agonist trigger–individualized, HCG-based, progesterone-free luteal support in ‘high responders’: a case series. Reprod Biomed Online 2015;31(6):747–751.Google Scholar
Vanetik, S, Segal, L, Breizman, T, et al. Day two post retrieval 1500 IUI hCG bolus, progesterone-free luteal support post GnRH agonist trigger–a proof of concept study. Gynecol Endocrinol 2018;34(2):132–135.Google Scholar
Fatemi, HM, Popovic-Todorovic, B. Implantation in assisted reproduction: a look at endometrial receptivity. Reprod Biomed Online 2013;27(5):530–538.CrossRefGoogle Scholar
Devroey, P, Polyzos, NP, Blockeel, C. An OHSS-Free Clinic by segmentation of IVF treatment. Hum Reprod 2011;26(10):2593–2597.Google Scholar
Garcia-Velasco, JA. Agonist trigger: what is the best approach? Agonist trigger with vitrification of oocytes or embryos. Fertil Steril 2012;97(3):527–528.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×