使用GnRHa 破卵  2天後只使用一次1500iu HCG  可取代傳統傳統植入後黃體素補充

Comparison of clinical outcomes after two different oocytes triggering protocols and associated luteal phase support: GnRH agonist triggering followed by 1500 IU of hCG 48 hours post oocyte retrieval, and hCG triggering followed by vaginal progesterone

Shahar Kol

Linoy Segal

Published:July 30, 2020DOI:https://doi.org/10.1016/j.rbmo.2020.07.024

GnRH agonist trigger after GnRH antagonist-based ovarian stimulation protocol for IVF is gaining popularity, because it prevents ovarian hyper-stimulation syndrome, and allows for near physiological LH and FSH surges. Small dose of hCG (1500 IU) on the day of oocyte retrieval, followed by daily progesterone administration, is currently the preferred way to secure adequate luteal support following GnRH agonist trigger. In the current study, we questioned the possibility that a bolus of 1500 IU hCG, given two days after oocyte retrieval, may be sufficient to sustain adequate luteal support without additional progesterone treatment.

Design

This is a non-interventional retrospective cohort study. From April 2017 to August 2018, we included data of 154 consecutive patients who were treated with GnRH agonist trigger followed by day two hCG (1500 IU) support only (study group). Data were compared with 155 consecutive patients who were treated with hCG (6500 IU) trigger followed by conventional progesterone luteal support (control group).

Results

Pregnancy, miscarriage and live birth rates were comparable between the study and control groups. In those patients who became pregnant, mean estradiol level 14 days post oocyte retrieval was 4,719 pmol/l and 2,672 pmol/l in the study and control group, respectively (P<.001), reflecting robust luteal activity in the study group.

Conclusions

We conclude that a bolus of 1500 IU hCG, administered two days after retrieval, can provide excellent luteal support, without the need for further progesterone supplementation.