IVF success rates can be excellent for high responding women when using a Lupron trigger.
Gurnee, IL (PRWEB) January 15, 2015
Board-certified fertility specialist Richard Sherbahn, MD recently presented research on the use of a Lupron trigger (agonist trigger) to prevent ovarian hyperstimulation in women with a high response to ovarian stimulation for IVF at the annual meeting of the American Society for Reproductive Medicine in Honolulu, Hawaii. The study, conducted by Dr. Sherbahn and Dr. Catenacci of Advanced Fertility Center of Chicago, looked at IVF live birth success rates, pregnancy loss rates, and ovarian hyperstimulation syndrome (OHSS) occurrence rates in high responders that had a pure Lupron trigger vs. a dual trigger with Lupron and a small dose of HCG.
Included in the study were 135 women under the age of 38, all using their own eggs for in-vitro fertilization (IVF). They each either received a pure Lupron trigger or a Lupron trigger plus a small dose of HCG (1500-2000 units), between November 2011 and July 2013. Patients were separated into 2 groups based on their trigger injections (pure agonist trigger vs dual trigger). Intensive support was given in the luteal phase using intramuscular progesterone and oral or transdermal estradiol.
The mean number of eggs retrieved, miscarriage rates, and the rate of development of ovarian hyperstimulation syndrome were not significantly different between the pure Lupron trigger group and the dual trigger group. The live birth rate per egg retrieval was 52.6% in the pure agonist trigger group, while the dual trigger group rate was 64.4%. The difference was not statistically significant. There was a trend for higher pregnancy loss rates in the pure agonist group, but it was not statistically significant either.
The pure Lupron trigger group was then split into 2 groups according to the peak estradiol level - under or over 4000 pg/ml. The IVF live birth rate was significantly higher (p<0.05) in the group with peak estradiol levels greater than 4000 pg/ml (42.2% vs. 67.7%).
“Published studies on Lupron triggers, and other agonist drug triggers, have shown inconsistent results. We believe that, in the studies with poor IVF success rates, the patients were not given enough estrogen and progesterone support in the luteal phase and early pregnancy. We believe the luteal support needs to be aggressive, and must be continued into early pregnancy, until the placenta makes enough hormones to support the pregnancy,” explained Dr. Sherbahn.
The results of the study showed that live birth rates with IVF, using a pure agonist trigger, can be very high when intensive luteal support is given. Also, success rates using a pure Lupron trigger are significantly higher when the peak estradiol level is above 4000 pg/ml. Therefore, if the peak estradiol level is below 4000 pg/ml, a dual trigger with a low dose of 1500 IU of HCG should be considered.
“We believe that the Lupron trigger is a vital tool that has been available to IVF doctors for the last several years for reducing the occurrence of ovarian hyperstimulation – particularly in women with polycystic ovarian syndrome, PCOS. Before the Lupron trigger was available, there were significantly more cases of ovarian hyperstimulation syndrome, which is always uncomfortable for the woman, and in rare cases can result in severe medical complications,” said Sherbahn. Proper use of pure agonist triggers can result in excellent IVF success rates, and no ovarian hyperstimulation, or rare hyperstimulation cases with a dual trigger.
About The Advanced Fertility Center of Chicago
The Advanced Fertility Center of Chicago, with offices in Gurnee and Crystal Lake, Ill., offers advanced reproductive technology services such as in-vitro fertilization (IVF), intracytoplasmic sperm injection, preimplantation genetic diagnosis, egg freezing and egg donation.
The Center’s web site, http://www.advancedfertility.com, offers more than 300 articles on fertility issues and IVF. To schedule an appointment, call 847.662.1818.