Maternal and neonatal outcomes after gonadotropin releasing hormone agonist trigger for final oocyte maturation in patients undergoing in vitro fertilization

Capsule:
Gonadotropin-releasing hormone agonist trigger does not affect obstetrical or neonatal outcomes in antagonist cycles.

Authors:
Tara H. Budinetz, D.O., Jessica S. Mann, M.D., Daniel W. Griffin, M.D., Claudio A. Benadiva, M.D., John C. Nulsen, M.D., Lawrence L. Engmann, M.D.

Volume 102, Issue 3, Pages 753-758

Abstract:

Objective:
To compare the rate of congenital anomalies, obstetrical complications, and neonatal complications in antagonist cycles where either GnRH agonist (GnRHa) or hCG was used for final oocyte maturation.

Design:
Retrospective cohort study.

Setting:
University-based tertiary fertility center.

Patient(s):
Three hundred ninety-two women under 40 years of age who underwent controlled ovarian stimulation using a GnRH antagonist protocol and who had final oocyte maturation triggered with either a GnRHa or hCG that resulted in pregnancy and delivery after 16 weeks’ gestation.

Intervention(s):
GnRHa versus hCG trigger of final oocyte maturation.

Main Outcome Measure(s):
Congenital anomaly rates, obstetrical complications, and neonatal complications.

Result(s):
There were no significant differences in the rate of congenital anomalies between GnRHa and hCG trigger (6.6 vs. 9.2%). There were also no differences in the maternal complications (27.6 vs. 20.8%) or neonatal complications (19.7 vs. 20.0%) between the GnRHa trigger and hCG trigger groups.

Conclusion(s):
GnRHa trigger does not affect the rate of congenital anomalies or obstetrical or neonatal complications and remains a viable option in the prevention of ovarian hyperstimulation syndrome.

  • Amanda N. Kallen

    Dr. Budenitz – great study and definitely something that patients do ask about. One question for you – did any of the patients in your study undergo ICSI? If so, were there differences in ICSI use between hCG and GnRH agonist groups? Because of the (admittedly potential confounded) data regarding ICSI and birth defects – if there was to be a difference between the groups in ICSI vs IVF, I wonder if it might skew the data a bit. Curious to hear your thoughts – thank you!

  • Shvetha Zarek

    Congratulations to Dr. Budinetz and colleagues for addressing the issue of the safety of GnRH agonist for final oocyte maturation in maternal and neonatal health! This initial study is important and reassuring for patient counseling as use of GnRH agonist for final oocyte maturation increases. It is interesting that although the overall risk of adverse obstetrical outcomes did not differ between the two groups, it was higher than baseline, suggesting that infertility itself carries an increased risk of pregnancy complications.

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