Document Detail


Gonadotropin-releasing hormone agonist versus HCG for oocyte triggering in antagonist assisted reproductive technology cycles.
MedLine Citation:
PMID:  21249699     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Gonadotropin-releasing hormone (GnRH) antagonist protocols for pituitary down regulation in in vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI) allow the use of GnRH agonists for triggering final oocyte maturation. Currently, human chorionic gonadotropin (HCG) is still the standard medication for this purpose. The effectiveness of triggering with a GnRH agonist compared to HCG measured as pregnancy and ovarian hyperstimulation(OHSS) rates are unknown.
OBJECTIVES: To compare the effectiveness of a GnRH agonist with HCG for triggering final oocyte maturation in IVF and ICSI patients undergoing controlled ovarian hyperstimulation in a GnRH antagonist protocol followed by embryo transfer. 
SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE , EMBASE, the National Research Register, the Medical Research Council's Clinical Trials Register, and the NHS Centre for Reviews and Dissemination database. We also examined the reference lists of all known primary studies and review articles, citation lists of relevant publications and abstracts of major scientific meetings.
SELECTION CRITERIA: All randomised controlled studies (RCTs) reporting data comparing clinical outcomes for women undergoing IVF and ICSI cycles and using a GnRH agonist in comparison with HCG for final oocyte maturation triggering.
DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trial quality and extracted data.
MAIN RESULTS: We identified 11 RCTs (n = 1055). Eight studies assessed fresh autologous cycles and three studies assessed donor-recipient cycles. In fresh-autologous cycles, GnRH agonist was less effective than HCG in terms of the live birth rate per randomised woman (OR 0.44, 95% CI 0.29 to 0.68; 4 RCTs) and ongoing pregnancy rate per randomised woman (OR 0.45, 95% CI 0.31 to 0.65; 8 RCTs). For a group with a 30% live birth or ongoing pregnancy rate using HCG, the rate would be between 12% and 22% using an GnRH agonist. Moderate to severe ovarian hyperstimulation syndrome (OHSS) incidence per randomised woman was significantly lower in the GnRH agonist group compared to the HCG group (OR 0.10, 95% CI 0.01 to 0.82; 5 RCTs). For a group with a 3% OHSS rate using HCG the rate would be between 0% and 2.6% using GnRH agonist. In donor recipient cycles, there was no evidence of a statistical difference in the live birth rate per randomised woman (OR 0.92, 95% CI 0.53 to 1.61; 1 RCT).
AUTHORS' CONCLUSIONS: We do not recommend that GnRH agonists be routinely used as a final oocyte maturation trigger in fresh autologous cycles because of lowered live birth rates and ongoing pregnancy rates. An exception could be made for women with high risk of OHSS, after appropriate counselling.
Authors:
Mohamed Afm Youssef; Fulco Van der Veen; Hesham G Al-Inany; Georg Griesinger; Monique H Mochtar; Ismail Aboulfoutouh; Sherif M Khattab; Madelon van Wely
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Publication Detail:
Type:  Journal Article; Meta-Analysis; Review     Date:  2011-01-19
Journal Detail:
Title:  The Cochrane database of systematic reviews     Volume:  -     ISSN:  1469-493X     ISO Abbreviation:  Cochrane Database Syst Rev     Publication Date:  2011  
Date Detail:
Created Date:  2011-01-20     Completed Date:  2011-02-28     Revised Date:  2013-06-28    
Medline Journal Info:
Nlm Unique ID:  100909747     Medline TA:  Cochrane Database Syst Rev     Country:  England    
Other Details:
Languages:  eng     Pagination:  CD008046     Citation Subset:  IM    
Affiliation:
Obstetrics & Gynaecology, Faculty of Medicine - Cairo University, Cairo, Egypt, 1105AZ.
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MeSH Terms
Descriptor/Qualifier:
Chorionic Gonadotropin / therapeutic use*
Female
Fertilization in Vitro*
Gonadotropin-Releasing Hormone / agonists*
Humans
Oocyte Donation / methods
Oocytes / drug effects,  growth & development
Ovarian Hyperstimulation Syndrome / epidemiology
Ovulation Induction / methods*
Pregnancy
Pregnancy Rate
Randomized Controlled Trials as Topic
Sperm Injections, Intracytoplasmic*
Chemical
Reg. No./Substance:
0/Chorionic Gonadotropin; 33515-09-2/Gonadotropin-Releasing Hormone
Comments/Corrections
Update Of:
Cochrane Database Syst Rev. 2010;(11):CD008046   [PMID:  21069701 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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