Volume 15, Issue 11 (11-2017)                   IJRM 2017, 15(11): 735-740 | Back to browse issues page

XML Persian Abstract Print

Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:

Aghahosseini M, Aleyasin A, Chegini V, Chegini V. Low-dose hCG as trigger day and 35 hr later have different ovarian hyperstimulation syndrome occurrence in females undergoing In vitro fertilization: An RCT. IJRM. 2017; 15 (11) :735-740
URL: http://journals.ssu.ac.ir/ijrmnew/article-1-907-en.html
1- Department of Infertility, Tehran University of Medical Sciences, Tehran, Iran
2- Department of Obstetrics and Gynecology, Qazvin University of Medical Sciences, Qazvin, Iran. , venus_chegini@yahoo.com
3- Qazvin University of Medical Sciences, Qazvin, Iran.
Abstract:   (193 Views)
Background: Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic complication, which can cause high morbidity and mortality. Use of gonadotropin releasing hormone (GnRH) agonist instead of human chorionic gonadotropin (hCG) in GnRH antagonist cycles causes luteinizing hormone surge by GnRH stimulation which reduces the risk of OHSS by reducing the total amount of gonadotropin; however, there is no possibility of transferring fresh embryos.
Objective: The current study aimed to evaluate the effect of hCG along with GnRH agonist administration in the occurrence of OHSS and pregnancy rate in females undergoing in vitro fertilization.
Materials and Methods: The current randomized clinical trial was conducted on 80 cases in 2 groups. Gonal-F was used to stimulate the oocyte from the second day of menstruation. When follicle size was 12-14 mm, GnRH antagonist was added to the protocol till the detection of more than two follicles greater than 18 mm. Then, GnRH agonist was added to the protocol as a trigger. In group A, 35 hr after the administration of GnRH agonist, the low-dose human hCG, 1500 IU, was used. In group B, low-dose hCG, 1500 IU, was used at the same time by GnRH agonist administration. The rate of pregnancy, OHSS, and its severity were compared between 2 groups within 2 wk.
Results: There was no significant difference regarding chemical and clinical pregnancies between the 2 groups. Severe OHSS was significantly higher in group B (p= 0.03).
Conclusion: Administration of hCG 35 hr after GnRH agonist administration results in lower rate of severe OHSS.
Full-Text [PDF 228 kb]   (87 Downloads) |   |   Full-Text (HTML)  (14 Views)  
Type of Study: Original Article |
Received: 2018/01/8 | Accepted: 2018/01/8 | Published: 2018/01/8

1. Tanha FD, Mohseni M, Ghajarzadeh M. Sexual function in women with primary and secondary infertility in comparison with controls. Int J Impot Res 2014; 26: 132-134. [DOI:10.1038/ijir.2013.51]
2. Macklon NS, Stouffer RL, Giudice LC, Fauser BC. The science behind 25 years of ovarian stimulation for in vitro fertilization. Endocr Rev 2006; 27: 170-207. [DOI:10.1210/er.2005-0015]
3. Verberg MF, Eijkemans MJ, Macklon NS, Heijnen EM, Baart EB, Hohmann FP, et al. The clinical significance of the retrieval of a low number of oocytes following mild ovarian stimulation for IVF: a meta-analysis. Hum Reprod Update 2009; 15: 5-12. [DOI:10.1093/humupd/dmn053]
4. Nastri CO, Teixeira DM, Moroni RM, Leitão VM, Martins WP. Ovarian hyperstimulation syndrome: pathophysiology, staging, prediction and prevention. Ultrasound Obstet Gynecol 2015; 45: 377-393. [DOI:10.1002/uog.14684]
5. Sousa M, Cunha M, da Silva JT, Oliveira C, Silva J, Viana P, et al. Ovarian hyperstimulation syndrome: a clinical report on 4894 consecutive ART treatment cycles. Reprod Biol Endocrinol 2015; 13: 66. [DOI:10.1186/s12958-015-0067-3]
6. Horstkamp B. Internal jugular vein thrombosis: a late complication of ovarian hyperstimulation syndrome. Hum Reprod 1996; 11: 1358-1359. [DOI:10.1093/oxfordjournals.humrep.a019390]
7. Li HW, Lee VC, Lau EY, Yeung WS, Ho PC, Ng EH. Cumulative live-birth rate in women with polycystic ovary syndrome or isolated polycystic ovaries undergoing in-vitro fertilisation treatment. J Assist Reprod Genet 2014; 31: 205-211. [DOI:10.1007/s10815-013-0151-6]
8. Nastri CO, Ferriani RA, Rocha IA, Martins WP. Ovarian hyperstimulation syndrome: pathophysiology and prevention. J Assist Reprod Genet 2010; 27: 121-128. [DOI:10.1007/s10815-010-9387-6]
9. Smith V, Osianlis T, Vollenhoven B. Prevention of Ovarian Hyperstimulation Syndrome: A Review. Obstet Gynecol Int 2015; 2015: 514159. [DOI:10.1155/2015/514159]
10. Elchalal U, Schenker JG. The pathophysiology of ovarian hyperstimulation syndrome-views and ideas. Hum Reprod 1997; 12: 1129-1137. [DOI:10.1093/humrep/12.6.1129]
11. Rizk B, Aboulghar M, Smitz J, Ron-El R. The role of vascular endothelial growth factor and interleukins in the pathogenesis of severe ovarian hyperstimulation syndrome. Hum Reprod Update 1997; 3: 255-266. [DOI:10.1093/humupd/3.3.255]
12. Delvigne A. Epidemiology of OHSS. Reprod Biomed online 2009; 19: 8-13. [DOI:10.1016/S1472-6483(10)60040-5]
13. Papanikolaou EG, Pozzobon C, Kolibianakis EM, Camus M, Tournaye H, Fatemi HM, et al. Incidence and prediction of ovarian hyperstimulation syndrome in women undergoing gonadotropin-releasing hormone antagonist in vitro fertilization cycles. Fertil Steril 2006; 85: 112-120. [DOI:10.1016/j.fertnstert.2005.07.1292]
14. Fauser BC, Diedrich K, Devroey P. Predictors of ovarian response: progress towards individualized treatment in ovulation induction and ovarian stimulation. Hum Reprod Update 2008; 14: 1-14. [DOI:10.1093/humupd/dmm034]
15. Humaidan P, Quartarolo J, Papanikolaou EG. Preventing ovarian hyperstimulation syndrome: guidance for the clinician. Fertil Steril 2010; 94: 389-400. [DOI:10.1016/j.fertnstert.2010.03.028]
16. Maftei R, Simionescu G, Neculai-Valeanu SA, Mocanu E, Doroftei B. Ovarian hyperstimulation syndrome after GnRH agonist trigger and rhCG luteal rescue protocol. Arch Clin Cases 2016; 3: 149-152. [DOI:10.22551/2016.13.0304.10085]
17. Bodri D. Low-dose hCG supplementation after GnRH agonist triggering: don't be too quick on the trigger. Hum Reprod 2013; 28: 2315-2317. [DOI:10.1093/humrep/det125]
18. Shapiro BS, Daneshmand ST, Garner FC, Aguirre M, Thomas S. 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: 231-233. [DOI:10.1016/j.fertnstert.2007.06.030]
19. Humaidan P, Bredkjær HE, Westergaard LG, Andersen CY. 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: 847-854. [DOI:10.1016/j.fertnstert.2008.12.042]
20. 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; 3437-3442. [DOI:10.1093/humrep/der333]
21. Seyhan A, Ata B, Polat M, Son WY, Yarali H, Dahan MH. Severe early ovarian hyperstimulation syndrome following GnRH agonist trigger with the addition of 1500 IU hCG. Hum Reprod 2013; 28: 2522-2528. [DOI:10.1093/humrep/det124]
22. 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; 14: 682-685. [DOI:10.1016/S1472-6483(10)60668-2]
23. Humaidan P, Polyzos NP, Alsbjerg B, Erb K, Mikkelsen AL, Elbaek HO, 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: 2511-2521. [DOI:10.1093/humrep/det249]
24. Youssef MA, Van der Veen F, Al-Inany HG, Mochtar MH, Griesinger G, Nagi Mohesen M, et al. Gonadotropin-releasing hormone agonist versus HCG for oocyte triggering in antagonist-assisted reproductive technology. Cochrane Database Syst Rev 2014; 10: CD008046. [DOI:10.1002/14651858.CD008046.pub4]
25. Goldsmith LT, Weiss G. Relaxin in human pregnancy. Ann N Y Acad Sci 2009; 1160: 130-135. [DOI:10.1111/j.1749-6632.2008.03800.x]
26. Weissman A, Loumaye E, Shoham Z. Recovery of corpus luteum function after prolonged deprivation from gonadotrophin stimulation. Hum Reprod 1996; 11: 943-949. [DOI:10.1093/oxfordjournals.humrep.a019329]
27. Kessler MJ, Reddy MS, Shah RH, Bahl OP. Structures of N-glycosidic carbohydrate units of human chorionic gonadotropin. J Biol Chem 1979; 254: 7901-7908.
28. Beckers NG, Macklon NS, Eijkemans MJ, Ludwig M, Felberbaum RE, Diedrich K, et al. Nonsupplemented luteal phase characteristics after the administration of recombinant human chorionic gonadotropin, recombinant luteinizing hormone, or gonadotropin-releasing hormone (GnRH) agonist to induce final oocyte maturation in in vitro fertilization patients after ovarian stimulation with recombinant follicle-stimulating hormone and GnRH antagonist cotreatment. J Clin Endocrinol Metab 2003; 88: 4186-4192. [DOI:10.1210/jc.2002-021953]
29. Humaidan P, Bredkjær HE, Bungum L, Bungum M, Grøndahl ML, Westergaard 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: 1213-1220. [DOI:10.1093/humrep/deh765]
30. Humaidan P, Bungum L, Bungum M, Yding Andersen C. Rescue of corpus luteum function with peri-ovulatory HCG supplementation in IVF/ICSI GnRH antagonist cycles in which ovulation was triggered with a GnRH agonist: a pilot study. Reprod Biomed Online 2006; 13: 173-178. [DOI:10.1016/S1472-6483(10)60612-8]
31. Youssef MA, Abdelmoty HI, Ahmed MA, Elmohamady M. GnRH agonist for final oocyte maturation in GnRH antagonist co-treated IVF/ICSI treatment cycles: Systematic review and meta-analysis. J Adv Res 2015; 6: 341-349. [DOI:10.1016/j.jare.2015.01.005]

Add your comments about this article : Your username or Email:

Send email to the article author

© 2018 All Rights Reserved | International Journal of Reproductive Biomedicine

Designed & Developed by : Yektaweb