AUTHOR=Martazanova Bella , Mishieva Nona , Vedikhina Irina , Kirillova Anastasia , Korneeva Irina , Ivanets Tatyana , Abubakirov Aydar , Sukhikh Gennady T. 

TITLE=Hormonal profile in early luteal phase after triggering ovulation with gonadotropin-releasing hormone agonist in high-responder patients

JOURNAL=Frontiers in Endocrinology

VOLUME=Volume 13 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2022.834627

DOI=10.3389/fendo.2022.834627

ISSN=1664-2392

ABSTRACT=The major limitations associated with gonadotropin-releasing hormone agonist (GnRHa) triggering are inferior clinical outcomes in fresh embryo transfer cycles caused by luteal phase insufficiency following the GnRHa triggering. We included 153 high-risk patients in this study. In group I, the women received gonadotropin-releasing hormone agonists (GnRHa)  trigger + 1500 IU human chorionic gonadotropin (hCG) support on the oocyte pick-up (OPU) day; in group II, the patients had a  dual trigger (GnRHa  + 1500 IU hCG); and in the control group III, 10000 IU hCG trigger was prescribed for the final oocyte maturation. The levels of LH, estradiol, and progesterone were evaluated in serum on the stimulation stating day, day six of stimulation, on the day of the trigger administration, OPU day, days 3 and 5 post-OPU, and day 14 post-ET, and in follicular fluid.  Progesterone concentration was significantly lower in group I on OPU+5 compared to the hCG group (I vs. III, р = 0,0065). Progesterone levels were significantly lower in group II in serum on OPU+5 day compared to group I and III (I vs. II, р = 0,0068; II vs. III, р = 1,76x108). The progesterone levels were significantly higher in follicular fluid in group III compared to studies groups (I vs. III, р = 0,002; II vs. III, p=0,009). However, no significant differences in clinical outcomes were found between the groups. Then we divided all women into pregnant and non-pregnant groups, and find that estradiol (p=0,00009) and progesterone (p=0,000036) on the day of the pregnancy test were significantly higher in the pregnant women group. Also, progesterone on OPU day was significantly higher in the non-pregnant group (p=0,033). 
Two cases of moderate OHSS late-onset occurred in group I (3,5%, 2/56), no case of moderate/severe OHSS late-onset in group II, and three cases of moderate late-onset in group III (5,7%, 3/53). 
The low-dose hCG supplementation improves the luteal phase insufficiency after GnRHa triggering, which is confirmed by the comparable pregnancy rates in fresh transfer cycles between the groups. However, low-dose hCG carries a similar risk of OHSS as a full dose of hCG in high-responder patients.