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How far is too far? Does time interval between GnRH antagonist and GnRH agonist trigger in GnRH antagonist cycles matter?

Authors
  • Hershko Klement, Anat1
  • Orvieto, Raoul2
  • Esh Broder, Efrat3
  • Frei, Judith4
  • Solnica, Amy5
  • Zandman, Orit4
  • Holzer, Hananel3
  • Haas, Jigal2
  • 1 Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Mt. Scopus Jerusalem, Israel; Faculty of Medicine, The Hebrew University Jerusalem, Israel. Electronic address: [email protected] , (Israel)
  • 2 Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hasomer, Israel; The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. , (Israel)
  • 3 Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Mt. Scopus Jerusalem, Israel; Faculty of Medicine, The Hebrew University Jerusalem, Israel. , (Israel)
  • 4 Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hasomer, Israel. , (Israel)
  • 5 Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Mt. Scopus Jerusalem, Israel; Henrietta Szold School of Nursing, Faculty of Medicine, The Hebrew University Jerusalem, Israel. , (Israel)
Type
Published Article
Journal
Reproductive biomedicine online
Publication Date
Aug 01, 2021
Volume
43
Issue
2
Pages
233–238
Identifiers
DOI: 10.1016/j.rbmo.2021.05.004
PMID: 34215488
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

What is a suitable time interval between the last GnRH antagonist exposure and GnRH agonist (GnRHa) triggering for final follicular maturation? A retrospective cohort study including 413 patients undergoing GnRH antagonist cycles in which GnRHa trigger was used, either solely or as a dual trigger. The primary outcome measure was the follicle/mature oocyte ratio. Cycles were analysed according to the time interval between the last GnRH antagonist exposure and the GnRHa triggering: Group 1 included patients with a 12-14 h interval; Group 2: 7-10 h interval; Group 3: 5-6 h interval and Group 4: 2-4 h interval. LH concentration was measured 11-13 h post-GnRHa injection. Median LH value was 65 IU/l. There was a weak but significant correlation between basal LH and the LH surge (R2 = 0.137, P < 0.001). Although square root LH values differed significantly between study groups (P < 0.001; higher in Groups 2 and 3), the follicle/mature oocyte ratio was not different across the four antagonist-agonist interval groups and no correlation was detected between the post-trigger LH concentration and the follicle/oocyte ratio (R2 = 0.011). In a model integrating age, day 3 FSH concentration, maximal oestradiol and body mass index along with the study groups, none of these factors was significantly related to the follicle/mature oocyte outcome ratio. Insufficient surge (LH < 15 IU/l) occurred in 14 (3.4%) cases. Rates of insufficient LH surge did not differ significantly between the groups (2.4%, 3.2%, 3.4% and 7.1% in Groups 1 to 4, respectively; P = 0.5). LH concentrations post-GnRHa trigger differ in regard to antagonist-agonist intervals, but the follicle/mature oocyte ratio achieved was not affected. Copyright © 2021. Published by Elsevier Ltd.

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