Dual Trigger" in IVF Patients at High Risk of Ovarian Hyper Stimulation Syndrome

Launched by MOUNT SINAI HOSPITAL, CANADA · Dec 2, 2022

Keywords

ClinConnect Summary

While the use of GnRH-a trigger has nearly eliminated the risk of OHSS, several studies have shown that this strategy may be associated with poorer IVF outcomes after a fresh embryo transfer (Engmann et al., 2008; Galindo et al., 2009; Melo et al., 2017; Sismanoglu et al., 2009; Youssef et al., 2014). These findings may be partly explained by an inadequate LH surge, following a GnRH-a trigger, and raises two separate concerns. The first concern is whether an inadequate LH surge can have an detrimental effect on luteal support following a fresh embryo transfer. The corpus luteum requires con...

Gender

FEMALE

Eligibility criteria

• Inclusion Criteria:
• • They are between the ages of 18 and 40.
• • They are undergoing IVF treatment with a GnRH antagonist protocol.
• * During their current treatment cycle, they have at least one of the following risk factors for OHSS:
• • Greater or equal to 13 follicles measuring at least 11 mm on the day of trigger.
• • Serum estradiol levels greater or equal to 15,000 pmol/L on the day of trigger.
• Exclusion Criteria:
• • They are using a GnRH agonist protocol (which is a contraindication to using a GnRH agonist trigger).
• • They are planning on using a "dual trigger" (based on poor outcomes in a previous IVF cycle using a GnRH agonist trigger).
• • They have a low ovarian reserve (AFC \< 7 follicles or AMH \< 10 pmol/L).
• • They have had a previous failed GnRH agonist trigger.
• • They have a known diagnosis of hypogonadotropic hypogonadism.
• • They have had a previous adverse or allergic reaction to GnRH agonist in the past.
• • They are using surgically retrieved sperm.
• • They are undergoing treatment for fertility preservation (oncofertility patients).
• • They have a history of recurrent implantation failure (defined as no clinical pregnancy after transfer of \> 4 good-quality embryos).
• • They have any congenital or acquire uterine anomalies distorting the uterine cavity.
• • If serum estradiol levels are equal or exceed 28,000 pmol/L on the day of trigger

Trial Officials