Comparative analysis of the effectiveness of an assisted reproductive technology program depending on an ovulation trigger
Objective. To evaluate the effect of the type of an ovulation trigger on the clinical and embryological indicators of the effectiveness of IVF/ICSI programs in patients with a normal ovarian response to superovulation stimulation.Eapen S.M., Pavlovich S.V., Mishieva N.G., Abubakirov A.N., Martazanova B.A.
Subjects and methods. The investigation enrolled 250 patients who were divided into 2 groups according to the injected ovulation trigger: 1) 125 patients who received human chorionic gonadotropin (hCG); 2) 125 patients who took a gonadotropin-releasing hormone agonist (GnRH-A). The luteal phase was supported by micronized progesterone at a dose of 600 mg/day in Groups 1 and 2. In Group 2, for luteal phase support, the investigators additionally injected once hCG at a dose of 1,500 IU on the day of transvaginal ovarian drilling (TOD) and estradiol valerate (Progynova, 4 mg/day) on the following day after TOD.
Results. There were statistically significant differences in the incidence of mild ovarian hyperstimulation syndrome (OHSS) in Groups 1 and 2 (p < 0.02). Mild OHSS developed in 9 (6.5%) and 22 (16.9%) patients in the GnRH-A replacement and hCG groups, respectively. Comparison of the frequency of moderate OHSS revealed no statistically significant differences in the examined groups: 5.4% (n = 7) in Group 1 and 4.3% (n = 6) in Group 2. In Group 1, two patients developed severe OHSS and required hospital treatment. No case of severe OHSS was recorded in the GnRH-A group. Trigger ovulation replacement did not significantly affect the number of obtained follicles and oocytes in patients of both groups. At the same time, the number of mature MII cells was significantly higher in Group 2 patients. There were no statistically significant differences in clinical pregnancy, spontaneous abortion, and birth rates between the groups.
Conclusions. The use of GnRH-A as an ovulation trigger in the GnRH antagonist protocols enables the pregnancy rate to be achieved when modifying the luteal phase at the same frequency as in the use of hCG. Moreover, the rate of moderate or severe OHSS reduced to a minimum.
Keywords
gonadotropin-releasing hormone agonist
assisted reproductive technology
ovulation trigger replacement
ovarian hyperstimulation syndrome
pregnancy rate
Supplementary Materials
- Table 1. Characteristics of the protocols for stimulation of ovarian function in the IVF program in Groups 1 and 2
- Table 2. Comparison embryological characteristic indicators in groups 1 and 2
References
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Received 16.12.2017
Accepted 23.12.2017
About the Authors
Eapen S.М., graduate student, I.M. Sechenov First Moscow State Medical University.119991, Russia, Moscow, Bolshaya Pirogovskaya str. 2-4. Тel.: +79260032600. Е-mail: dr.snehaeapen@gmail.com
Pavlovich S.V., PhD, Associate Professor, Scientific Secretary of Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia.
Address: 117997, Russia, Mosсow, Ac. Oparina str. 4. Тel.: +79104244197. E-mail: st.pavlovich@mail.ru
Mishieva N.G., MD, Senior researcher of 1st gynecology department, Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia.
Address: 117997, Russia, Mosсow, Ac. Oparina str. 4. Тel.: +79104244197. E-mail: nondoc555@mail.ru
Abubakirov A.N., PhD, Head of 1st gynecology department, Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia.
Address: 117997, Russia, Mosсow, Ac. Oparina str. 4. Тel.: +74954382622. Е-mail: nondoc555@yahoo.com
Martazanova B.A., Research assistant, Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia.
Address: 117997, Russia, Mosсow, Ac. Oparina str. 4. Тel.: +79671238824. Е-mail: bellamart88@mail.ru
For citations: Eapen S.M., Pavlovich S.V., Mishieva N.G., Abubakirov A.N.,
Martazanova B.A. Comparative analysis of the effectiveness
of an assisted reproductive technology program depending on an ovulation trigger.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2017; (6): 99-103. (in Russian)
http://dx.doi.org/10.18565/aig.2017.6.99-103
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