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. 2022 Feb;39(2):291-303.
doi: 10.1007/s10815-021-02359-y. Epub 2022 Mar 19.

Prediction, assessment, and management of suboptimal GnRH agonist trigger: a systematic review

Hadas Ganer Herman  1 , Eran Horowitz  2 , Yossi Mizrachi  2 , Jacob Farhi  2 , Arieh Raziel  2 , Ariel Weissman  2
Affiliations

Prediction, assessment, and management of suboptimal GnRH agonist trigger: a systematic review

Hadas Ganer Herman et al. J Assist Reprod Genet. 2022 Feb.

Abstract

Purpose: This systematic review aimed to identify baseline patient demographic and controlled ovarian stimulation characteristics associated with a suboptimal response to GnRHa triggering, and available options for prevention and management of suboptimal response.

Methods: PubMed, Google Scholar, Medline, and the Cochrane Library were searched for keywords related to GnRHa triggering, and peer-reviewed articles from January 2000 to September 2021 included.

Results: Thirty-seven studies were included in the review. A suboptimal response to GnRHa triggering was more likely following long-term or recent oral contraceptive use and with a low or high body mass index. Low basal serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), and estradiol serum levels were correlated with suboptimal oocyte yield, as was a low serum LH level on the day of triggering. A prolonged stimulation period and increased gonadotropin requirements were correlated with suboptimal response to triggering. Post-trigger LH < 15 IU/L best correlated with an increased risk for empty follicle syndrome and a lower oocyte retrieval rate. Retriggering with hCG may be considered in patients with suboptimal response according to post-trigger LH, as in cases of failed aspiration.

Conclusion: Pre-treatment assessment of patient characteristics, with pre- and post-triggering assessment of clinical and endocrine cycle characteristics, may identify cases at risk for suboptimal response to GnRHa triggering and optimize its utilization.

Keywords: GnRH agonist (GnRHa); In vitro fertilization (IVF); Luteinizing hormone (LH); Ovulation triggering; Review.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram of search results
Fig. 2
Fig. 2
Proposed four-step strategy for optimizing the efficacy of GnRHa triggering
See this image and copyright information in PMC

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