GnRH antagonist rescue in high responders at risk for OHSS results in excellent assisted reproduction outcomes

Abstract Gonadotrophin-releasing hormone (GnRH) antagonist rescue is performed by replacing a GnRH agonist with a GnRH antagonist in patients with rapidly rising serum oestradiol who are at risk of ovarian hyperstimulation syndrome (OHSS) during stimulation. It results in a rapid reduction in serum...

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Published in:Reproductive biomedicine online 2012-09, Vol.25 (3), p.284-291
Main Authors: Hill, Micah J, Chason, Rebecca J, Payson, Mark D, Segars, James H, Csokmay, John M
Format: Article
Language:English
Subjects:
Adult
assisted reproduction
Blastocyst - physiology
cancellation
Estradiol - blood
Female
Fertilization
Fertilization in Vitro - methods
GnRH antagonist rescue
Gonadotropin-Releasing Hormone - antagonists & inhibitors
Gonadotropins - metabolism
Hormone Antagonists - pharmacology
Humans
infertility
IVF
Male
Obstetrics and Gynecology
OHSS
Oocytes - cytology
Ovarian Hyperstimulation Syndrome - drug therapy
Ovarian Hyperstimulation Syndrome - prevention & control
Pregnancy
Pregnancy Outcome
Pregnancy Rate
Reproductive Techniques, Assisted
Retrospective Studies
Risk
Treatment Outcome
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Summary:Abstract Gonadotrophin-releasing hormone (GnRH) antagonist rescue is performed by replacing a GnRH agonist with a GnRH antagonist in patients with rapidly rising serum oestradiol who are at risk of ovarian hyperstimulation syndrome (OHSS) during stimulation. It results in a rapid reduction in serum oestradiol, allowing for the avoidance of cycle cancellation and the continuation of exogenous gonadotrophin administration. A total of 387 patients who underwent GnRH antagonist rescue for ovarian hyperresponse were compared with 271 patients who did not receive GnRH antagonist rescue and had oestradiol concentrations >4000 pg/ml on the day of human chorionic gonadotrophin (HCG) administration. GnRH antagonist rescue decreased the mean oestradiol concentration by 35% on the first day of use. There was no difference in oocyte maturity (82% versus 83%) or fertilization rate (69% versus 67%) between the antagonist rescue and comparison groups, respectively. The percentage of high-grade embryos on day 3 and the blastocyst development rate were also similar between groups. The live-birth rate was 41.9% in the antagonist rescue group and 36.9% in the comparison group. GnRH antagonist rescue enabled cycle completion with high live-birth rates in patients at risk for OHSS. GnRH antagonist was associated with high oocyte quality, blastocyst development and pregnancy. Gonadotrophin-releasing hormone (GnRH) antagonist rescue is a protocol to reduce the risk of ovarian hyperstimulation syndrome (OHSS) in assisted reproduction treatment. Patients who have a hyperresponse to medication during their treatment cycle have their GnRH agonist discontinued and a GnRH antagonist started in its place. This causes a rapid reduction in oestrogen concentrations and allows for the continuation of stimulation medication. We evaluated the effectiveness of this protocol by comparing patients who had GnRH antagonist rescue against high-responding patients who did not receive GnRH antagonist rescue. GnRH antagonist rescue resulted in a 35% reduction in oestrogen concentration and only a 1.5% cycle cancellation rate. There were no differences in oocyte maturity or fertilization between the two groups. There were no differences in the quality of day-3 and day-5 embryos between the two groups. The live birth rate was 41.9% in the antagonist rescue group and 36.9% in the comparison group. GnRH antagonist rescue reduced serum oestradiol concentrations and enabled cycle completion with high live-b
ISSN:1472-6483
1472-6491
DOI:10.1016/j.rbmo.2012.05.004