We described the use of GnRH agonist to induce endogenous LH surge during an ovarian stimulation cycle with GnRH-nt (61). All patients showed an appropriate LH and progesterone rise after the GnRH agonist administration, confirming that this approach can be used to induce LH secretion during the final stage of COH.
Others (84-87) previously proposed this strategy to decrease the risk of OHSS, as the endogenous LH has a lower half-life than hCG. However, this approach is not suitable in patients previously down-regulated with GnRH agonist.
A recent study, comparing hCG, Lupron (0.2 mg), and Triptorelin (0.1 mg) to trigger ovulation in IVF patients treated with Ganirelix, found similar IVF-ET results between the three groups of patients (88). Other studies found lower pregnancy rates in patients treated with a combination of GnRH-nts and agonists (89). A small group of high responders were treated with a combination of GnRH-nt and agonists and no OHSS was observed in this preliminary report (90). As mentioned earlier, a study using Antide as GnRH-nt showed an altered luteal phase in cycles combining GnRH-nt and agonist (81). Some authors advocate that the luteal phase needs to be supported by both progesterone and estrogens (Itskowitz, personal communication). In a prospective randomized study, reduced pregnancy rate was found in GnRH-nt cycle in which GnRH-a was used to trigger ovulation, despite using progesterone and estradiol as luteal supplementation (91).
More studies are needed before recommending this approach.
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