Hum. Reprod. Advance Access published online on February 15, 2007
Human Reproduction, doi:10.1093/humrep/dem006
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Elective cryopreservation of all pronuclear oocytes after GnRH agonist triggering of final oocyte maturation in patients at risk of developing OHSS: a prospective, observational proof-of-concept study
Department of Obstetrics and Gynecology, University Clinic of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
1 To whom correspondence should be addressed at: Department of Obstetrics and Gynecology, University Clinic of Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany. Tel: +49 451 500 2134; Fax: +49 451 500 2170; E-mail: georg.griesinger{at}frauenklinik.uni-luebeck.de
BACKGROUND: A bolus dose of GnRH agonist can substitute for hCG as a trigger for the resumption of meiosis in ovarian stimulation with GnRH antagonists, which has been suggested to reduce the risk of ovarian hyperstimulation syndrome (OHSS). As the efficacy of this measure in fresh embryo transfer (ET) cycles is unclear, we evaluated a new clinical concept of GnRH-agonist triggering.
METHODS: In this prospective, observational proof-of-concept study, 20 patients considered at increased risk of developing OHSS (
20 follicles 10 mm or estradiol 4000 pg/ml, or a history of cycle cancellation due to OHSS risk or the development of severe OHSS in a previous cycle) after ovarian stimulation and concomitant GnRH-antagonist administration had final oocyte maturation triggered with 0.2 mg triptorelin s.c. All two pronucleate (2 PN) oocytes were cryopreserved by vitrification, and frozen–thawed ETs (FT-ETs) were performed in an artificial cycle. Main outcome measures were the cumulative ongoing pregnancy rate per patient and the ongoing pregnancy rate per first ET. Secondary outcomes included the incidence of moderate-to-severe OHSS.
RESULTS: Of the 20 patients triggered with GnRH agonist, 19 patients underwent 24 FT-ETs in the observational period. The cumulative ongoing pregnancy rate was 36.8% (95% confidence interval: 19.1–59.0%). The ongoing pregnancy rate per first FT-ET was 31.6% (15.4–54.0%). No cases of moderate or severe OHSS were observed.
CONCLUSIONS: The present study is the proof of the concept that GnRH-agonist triggering of final oocyte maturation in combination with elective cryopreservation of 2 PN oocytes offers OHSS risk patients a good chance of pregnancy achievement, while reducing the risk of moderate and severe OHSS.
Key words: frozen–thawed embryo replacement/GnRH agonist/GnRH antagonist/ovarian hyperstimulation syndrome
Submitted on September 28, 2006; resubmitted on November 8, 2006; accepted on November 24, 2006.
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