Factors that predict the probability of a successful clinical outcome after induction of oocyte maturation with a gonadotropin-releasing hormone agonist

ObjectiveTo determine factors predicting cycle success after in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) in high-risk patients undergoing controlled ovarian stimulation with a gonadotropin-releasing hormone (GnRH) antagonist protocol with a GnRH agonist to induce oocyte maturation.DesignRetrospective cohort study.SettingUniversity-based tertiary fertility center.Patient(s)Women who underwent a GnRH antagonist protocol during IVF-ICSI cycles and received a GnRH agonist for oocyte maturation.Intervention(s)GnRH-agonist trigger.Main Outcome Measure(s)Clinical and ongoing pregnancy rates and any occurrence of ovarian hyperstimulation syndrome (OHSS).Result(s)The serum luteinizing hormone (LH) level on the day of trigger of oocyte maturation was the single most important predictor of clinical pregnancy. Patients with a peak estradiol (E2) level ≥4,000 pg/mL also had statistically significant higher serum LH on the day of the GnRH-agonist trigger and had a higher clinical pregnancy rate compared with those with a peak E2 level <4,000 pg/mL, although the two groups had comparable numbers of oocytes retrieved. No patients developed OHSS.Conclusion(s)Serum LH and E2 levels ≥4,000 pg/mL on the day of the GnRH-agonist trigger are important predictors of success in patients at high risk of OHSS development. As none of the patients in this high-risk population developed OHSS, the GnRH-agonist trigger is effective in the prevention of this iatrogenic complication.