Analysis of clinical outcome of whole frozen-thawed embryo transfer in patients with high ovarian response using GnRH-agonist trigger or combined with low-dose hCG trigger in GnRH-antagonist protocol
10.3760/cma.j.cn101441-20220406-00145
- VernacularTitle:拮抗剂方案卵巢高反应人群GnRH-a单药或联合低剂量hCG扳机全胚冻融临床结局分析
- Author:
Binbin TU
1
;
Ningning PAN
1
;
Lixue CHEN
1
;
Jin HUANG
1
;
Min LI
1
;
Rui YANG
1
;
Ping LIU
1
;
Rong LI
1
;
Jie QIAO
1
Author Information
1. 北京大学第三医院妇产科生殖医学中心，北京 100191
- Publication Type:Journal Article
- Keywords:
Gonadotropin-releasing hormone antagonist protocol;
Gonadotropin-releasing hormone agonist trigger;
Dual trigger;
Frozen-thawed embryo transfer
- From:
Chinese Journal of Reproduction and Contraception
2023;43(7):683-689
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To compare the clinical outcome of whole frozen-thawed embryo transfer in patients with high ovarian response using gonadotropin-releasing hormone agonist (GnRH-a) single trigger or combined with low-dose human chorionic gonadotropin (hCG) dual trigger in the gonadotropin-releasing hormone antagonist (GnRH-A) protocol.Methods:Retrospective cohort study was conducted in Center for Reproductive Medicine, Department of Obstetrics and Gynecology of Peking University Third Hospital between January 2018 to December 2020, and the patients with high ovarian response undergoing in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) were divided into GnRH-a single trigger group (group A, n=251) and GnRH-a combined with low-dose hCG dual trigger group (group B, n=741) according to the trigger protocol. The clinical outcome was compared between the two groups. Results:There were no significant differences in clinical characteristics between group A and group B. Estrogen level on the day of trigger, number of embryos formed, number of two pronuclei (2PN) embryos formed, number of high-quality embryos formed and rate of embryo formation in group A were significantly higher than those in group B [(22 905.84±9 513.28) pmol/L vs. (17 200.82±6 811.64) pmol/L, P<0.001; 18.84±9.50 vs. 17.34±8.04, P=0.025; 16.06±8.24 vs. 14.87±7.07, P=0.042; 11.25±6.92 vs. 10.25±5.97, P=0.027; 68.6% (4 730/6 899) vs. 66.5% (12 852/19 326), P=0.002]. However, there were no significant differences in number of oocytes retrieved, mature oocyte rate and high-quality embryo rate between group A and group B (all P>0.05). There were also no significant differences in hCG positive rate, clinical pregnancy rate, abortion rate, ectopic pregnancy rate, persistent pregnancy rate and live birth rate per frozen-thawed embryo transfer between the two groups (all P>0.05). There were no significant differences in cumulative persistent pregnancy rate, cumulative live birth rate, proportion of low birth weight infants and birth defects per ovarian stimulation cycle between the two groups (all P>0.05). The incidence of early-onset severe ovarian hyperstimulation syndrome (OHSS) in group A was lower than that in group B, but there was no significant difference [0% vs. 1.5% (11/741), P=0.075]. Conclusion:The pregnancy outcome of whole frozen-thawed embryo transfer in patients with high ovarian response using GnRH-a single trigger was comparable to dual trigger combined with low-dose hCG in the GnRH-A protocol, and the risk of early onset severe OHSS was low. Therefore, in patients with high ovarian response in IVF/ICSI cycle using GnRH-A protocol, the use of GnRH-a single trigger followed by whole frozen-thawed embryo transfer could be considered as an optimal choice to minimize the risk of early onset OHSS without loss of pregnancy outcome.
