Major drawbacks and additional benefits of agonist trigger Not ovarian hyperstimulation syndrome related
High responders and oocyte donors may now be stimulated and triggered with reasonable safety. This paradigm shift confers certain advantages and potential new risks.
Bruce S. Shapiro, M.D., Ph.D., Claus Yding Andersen, D.M.Sc.
Volume 103, Issue 4, Pages 874-878
The GnRH agonist trigger alters traditional IVF paradigms when compared with hCG-only triggers. The agonist trigger induces rapid luteolysis and therefore separates the oocyte maturation aspect of LH from the luteal support previously afforded by lingering hCG. This might allow customized and more optimal luteal support. The agonist trigger option also allows continued stimulation and subsequent trigger of high responders with reasonable safety, potentially leading to retrievals of larger cohorts of mature oocytes. It may also reduce the number of retrievals needed to achieve a large family. The agonist trigger might alter other paradigms as well, such as making oocyte donation more efficient per stimulation by virtually eliminating follicular-phase cycle cancellation, coasting, and premature triggering. There are both corresponding potential benefits and drawbacks of using the agonist trigger and the shifting paradigms it allows.