Random-start gonadotropin-releasing hormone (GnRH) antagonist–treated cycles with GnRH agonist trigger for fertility preservation

ObjectiveTo describe our experience with random-start IVF with the use of GnRH agonist for final oocyte maturation, to reduce the risk of ovarian hyperstimulation syndrome.DesignCase series.SettingUniversity-based center for reproductive endocrinology and infertility.Patient(s)Patients with a new diagnosis of cancer who presented with a narrow time frame for IVF before initiating cancer therapy.Intervention(s)Random-start GnRH antagonist cycles with GnRH agonist trigger for final oocyte maturation.Main Outcome Measure(s)Number of oocytes retrieved, fertilization rate, rates of ovarian hyperstimulation syndrome.ResultsCycles were started in the late follicular or luteal phase, and the duration of controlled ovarian hyperstimulation ranged between 8-13 days. A total of 14-40 oocytes were retrieved and 5-20 embryos cryopreserved for each patient.Conclusion(s)Random-start IVF is a reasonable option for fertility preservation in those cancer patients for whom the treatment window may be narrow. In addition, the use of a GnRH agonist for final oocyte maturation may decrease the potential risk of ovarian hyperstimulation syndrome.