Efficacy and Safety of Medication Used to Stimulate Ovulation
Status:
Recruiting
Trial end date:
2021-09-01
Target enrollment:
Participant gender:
Summary
Individuals undergoing In Vitro Fertilization must undergo controlled ovarian
hyperstimulation (COH) to produce enough quality eggs for fertility treatment. Ovarian
follicular responsiveness to COH with gonadotropins is extremely variable between patients
and even from cycle to cycle for the same patient. Achieving an ideal follicular response is
critical to the success of assisted reproduction treatment (ART). Patients have been
classified as 'poor', 'normal' or 'high' responders, which dictate the amount of
gonadotropins that they receive. It is still important to develop treatments with high
efficacy, lower multiple birth rates, and a lower complication rate for each of these groups.
In an era of evidence-based medicine and with special emphasis on reducing IVF risks (mainly
OHSS and pregnancies with multiples), it is very important to find optimal and safe ovulation
induction and triggering regimens for each patient population.
The use of GnRH agonist (GnRHa) triggering among high responders in order to reduce or
eliminate OHSS is an example of an important breakthrough in the clinical management of IVF
patients. Although GnRHa triggering was shown to be as effective as human chorionic
gonadotropin (hCG) at inducing oocyte maturation more than 20 years ago, its use to trigger
ovulation was not possible until the introduction of GnRH antagonists for pituitary
suppression.
Another prominent trend in ART in recent years has been the introduction of dual triggering,
which involves a combination of GnRHa plus hCG for triggering. This regimen creates
simultaneous lutenizing hormone (LH) and follicle stimulating hormone (FSH) surges by the
GnRHa, which resembles physiologic ovulation triggering, together with sustained LH-like
activity from the hCG, which stimulates the corpus luteum to excrete sufficient hormonal
endometrial support. Since its introduction, dual triggering has been gaining popularity due
to outstanding results in retrospective studies among both normal and high responders.
Moreover, in spite of the encouraging retrospective reports, prospective randomized
controlled trials (RCT) on dual triggering have not been reported to date. The aim of the
current proposed study is to compare the efficacy of dual triggering and conventional
triggering among the three IVF populations (high, normal and poor responders).