Abstract
OBJECTIVE: To investigate parameters predictive of pregnancy outcomes in high responders undergoing fresh, autologous, GnRH antagonist IVF/ICSI cycles using a GnRH agonist trigger. STUDY DESIGN: Retrospective cohort study of all patients deemed high-risk for ovarian hyperstimulation syndrome who underwent fresh, autologous IVF/ICSI using a GnRH agonist trigger at an academic fertility center from 2010–2012. RESULTS: A total of 71 first cycles were analyzed. Rates of clinical pregnancy, live birth (LB), and total (clinical plus biochemical) miscarriage (MC) were 52%, 38%, and 25%, respectively. Mean peak estradiol (E2) and the number of oocytes retrieved were 3,701 pg/mL and 15.2, respectively. Peak E2 was significantly higher in those cycles resulting in clinical MC (p=0.003). After adjusting for age, basal follicle stimulating hormone, and the number of oocytes retrieved, elevated peak E2 remained associated with increased clinical MC (p=0.029) and trended towards a relationship with higher total MC (p=0.062). When peak E2 was treated as a binary variable based on the threshold value of >5,000 pg/mL, peak E2 above this value was associated with a higher rate of clinical MC (OR=16.14 with 95% CI 1.25–209.35, p=0.033) and total MC (OR=6.81 with 95% CI 1.12–41.54, p=0.037), as well as a lower LB rate (OR= 0.095 with 95% CI 0.01–0.90, p=0.041). CONCLUSION: Clinicians should recognize most IVF/ICSI patients triggered with a GnRH agonist as inherently in danger of excessively high serum E2 and avoid peak levels >5,000 pg/mL in order to avoid higher MC and lower LB rates.
Original language | English (US) |
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Pages (from-to) | 463-470 |
Number of pages | 8 |
Journal | Journal of Reproductive Medicine |
Volume | 60 |
Issue number | 6 |
State | Published - Dec 2015 |
Keywords
- Agonists
- Assisted reproductive techniques
- Assisted reproductive technology
- Controlled ovarian hyperstimulation
- Estradiol
- Fertilization
- GnRH
- Gonadotropin-releasing hormone
- In vitro intracytoplasmic sperm injection
- Live birth
- Miscarriage
- Ovarian hyperstimulation syndrome
- Pregnancy outcome
- Spontaneous abortion
ASJC Scopus subject areas
- Reproductive Medicine
- Obstetrics and Gynecology