Reproductive BioMedicine Online
Volume 20, Issue 2 , Pages 175-181, February 2010

Cycles triggered with GnRH agonist: exploring low-dose HCG for luteal support

Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Hospital Clínico Universitario de Valencia, Blasco Ibañez Avenue 17, Valencia 46010, Spain

Received 28 January 2009; received in revised form 31 March 2009; accepted 11 November 2009. published online 28 December 2009.

Declaration: The authors report no financial or commercial conflicts of interest.

Abstract 

The aim of this study in patients at risk of ovarian hyperstimulation syndrome (OHSS) was to determine the efficacy and safety of luteal support using human chorionic gonadotrophin (HCG) after triggering ovulation with gonadotrophin-releasing hormone (GnRH) agonist in IVF/intracytoplasmic sperm injection antagonist cycles. A total of 192 OHSS-risk patients, following a GnRH antagonist protocol (0.25mg/day cetrorelix) during recombinant FSH stimulation, were triggered with 1.5mg s.c. leuproreline for ovulation. A total of three boluses of HCG were used for luteal support, 1000IU (group A, n=44), 500IU (group B, n=115) or 250IU (group C, n=33) every third day, starting the day after oocyte retrieval. For the reproductive outcome, main variables were biochemical and clinical pregnancy rates, and for OHSS, the variables were the numbers of moderate and severe OHSS cases. Overall pregnancy rate was 51.8% and clinical pregnancy rate was 43.4%. This study observed eight cases of moderate (4.2%) and seven of severe OHSS (3.6%). Six out of the seven (85.7%) severe cases were late-onset OHSS, related to pregnancy. In conclusion, GnRH agonist single dose for triggering ovulation and low doses of HCG used as luteal-phase support seem to secure a normal pregnancy outcome without increasing the OHSS risk.

Keywords: GnRH agonist, GnRH antagonist, HCG, OHSS

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 Juan Carlos Castillo obtained his MD degree in 1998 and his speciality degree in Obstetrics and Gynaecology in 2005 at the Grau Emergency Hospital, Lima, Perú. In 2006, he received his Master’s degree in Human Reproduction from the Universidad de Valencia, Spain. Since then he has been working as a consultant specialist in reproductive medicine at Hospital Clínico Universitario de Valencia, Spain. His PhD thesis at Universidad de Valencia is focused on the prevention of ovarian hyperstimulation syndrome and will be defended in late 2009.

PII: S1472-6483(09)00231-4

doi:10.1016/j.rbmo.2009.11.018

Reproductive BioMedicine Online
Volume 20, Issue 2 , Pages 175-181, February 2010

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