Kulvinder Kochar Kaur¹*, Gautam Allahbadia² and Mandeep Singh³

¹Scientific Director, Dr Kulvinder Kaur Centre for Human Reproduction, Jalandhar, Punjab, India
²Scientific Director, Rotunda-A Centre for Human Reproduction, Mumbai, India
³Consultant Neurologist, Swami Satyan and Hospital, Jalandhar, Punjab, India

*Corresponding Author: Kulvinder Kochar Kaur, Scientific Director, Dr Kulvinder Kaur Centre for Human Reproduction, Jalandhar, Punjab, India.

Received: July 14, 2023; Published: October 12, 2023

Abstract

Numerous studies have illustrated composed of with regards to human chorionic Gonadotropins (HCG) dosage in the canonical/standard HCG trigger (5000-10,000 IU) used for IVF trigger. However avoidance of ovarian hyperstimulation syndrome (OHSS) OHSS is not avoided. This has been further followed by utilizing 2000, 2500, or 3300 IU of HCG dosage for finding minimum efficacious dosage. Subsequently use of gonadotropin releasing hormone agonist (GnRH) trigger was introduced in view of natural LH/FSH surge trigger. Nevertheless, its disadvantage was we could not use it uniformly like in GnRH agonist downregulated cycles. Recently a randomized double blind controlled, non inferiority trial was introduced by Anaya Y., et al. where 1500 IU HCG with concurrent delivery of 450 IU of FSH was observed to be successful in IVF cycles with parallel utilized contrasting with 5000-10,000 IU also for the final oocyte maturation. They found reduced OHSS in this innovative trial. However a larger study is essential with regards to evaluation of embryo production as well as LBR results Although no cycles cancelled one needs to compare this with the recently introduced Dual trigger (HCG + GnRHa trigger) where they observed superiority of results in with regards to embryo formation as well as pregnancy results. One of the modes that might give reason for the enhancement in pregnancy rate is the escalation of receptivity along with implantation in view of the extra-pituitary actions of the GnRH molecule, which is implicated in endometrial receptivity, embryo implantation, and trophoblast invasion. The expression of HOXA-10, possesses a key part in modulating endometrial receptivity, is diminished in endometrial tissues in antagonist cycles as explained by Olieviera., et al.

Keywords: Innovative HCG Trigger; Standard HCG Trigger; OHSS; Dual Trigger

References

1. Conti M and Franciosi F. “Acquisition of oocytes competence to develop an embryo: integrated cytoplasmic and nucleus events”. Human Reproduction Update 24 (2018): 245-266.
2. Casarini L., et al. “LH and HCG actions on the same receptor results in quantitative and qualitative different intracellular signaling”. PLoS ONE 7 (2012): e46682.
3. Kolibianakis EM., et al. “Triggering final oocytes maturation using different doses of human chorionic gonadotropin: a randomized pilot study in patients with Polycystic ovary syndrome treated with gonadotropin releasing hormone antagonist and recombinant follicle stimulating hormone”. Fertility and Sterility 88 (2007): 1382-1388.
4. , et al. “The effects of the dose of human chorionic gonadotropin and the type of gonadotropin stimulation on oocyte recovery rates in an invitro fertilization program”. Fertility and Sterility 48 (1987): 958-963.
5. Kashyap S., et al. “Ovarian hyperstimulation syndrome prevention strategies: reducing the human chorionic gonadotropin dose”. Seminars in Reproductive Medicine 28 (2010): 475-485.
6. Isik AZ and Vicdan K. “Borderline form of Empty follicle syndrome: is it really an entity?” European Journal of Obstetrics and Gynecology and Reproductive Biology 88 (2000): 213-215.
7. Hoff JD., et al. “Hormonal dynamicsat midcycle: are evaluation”. The Journal of Clinical Endocrinology and Metabolism 57 (1983): 792-796.
8. Zelinsky-Wooten MB., et al. “Follicle stimulating hormone alone supports follicle growth and oocyte development in gonadotropin releasing hormone antagonist-treated monkeys”. Human Reproduction 10 (1995): 1658-1666.
9. Franciosi F., et al. “FSH regulates mRNA translation in mouse oocytes and promotes developmental competence”. Endocrinology 157 (2016): 872-82.
10. Zelinsky-WootenMB., et al. “A bolus of recombinant human follicle stimulating hormone at midcycle induces periovulatory events following multiple follicular development in macaques”. Human Reproduction 13 (1998): 554-560.
11. Banchi V., et al. “Inadvertent human recombinant follicle stimulating hormone bolus instead of human chorionic gonadotropin leads to retrieval of competent oocytes in IVF program”. Fertility and Sterility 92 (2009): 1747. e1-3.
12. Gonen Y., et al. “Use of gonadotropin releasing hormone agonist to trigger follicular maturation for invitro fertilization”. The Journal of Clinical Endocrinology and Metabolism 71 (1990): 918-922.
13. Erb TM., et al. “Gonadotropin releasing hormone agonist or human chorionic gonadotropinfor final oocyte maturation in an oocyte donor program”. Fertility and Sterility 93 (2010): 374-378.
14. Lamb JD., et al. “Follicle stimulating hormone administered at the time of human chorionic gonadotropin trigger improves oocyte developmental competence in invitro fertilization cycles: a randomized double blind, placebo controlled trial”. Fertility and Sterility 95 (2011): 1655-1660.
15. Anaya Y., et al. “A novel oocyte maturation trigger using 1500 IU human chorionic gonadotropin plus 450 IU of follicle stimulating hormone may decrease ovarian hyperstimulation syndrome across All invitro fertilization stimulation protocols”. Journal of Assisted Reproduction and Genetics 35 (2018): 297-307.
16. Anaya Y., et al. “Triggering with 1500 IU of human chorionic gonadotropin plus 450 IU of follicle stimulating hormone compared to a standard human chorionic gonadotropin trigger dose for oocytes competence in invitro fertilization cycles :a randomized double blind controlled, non inferiority trial”. Fertility and Sterility 118 (2022): 266-278.
17. Center for Drug Evaluation and Research C for BE and R. Non-inferiority clinical trials to establish effectiveness—guidance for industry. Silver Spring, Maryland (2016).
18. Gonzalez- Gonzalez V., et al. “Dual trigger vs. Conventional trigger outcomes in In Vitro Fertilization. Systematic review and meta-analysis”. JBRA Assistant Reproduction 1 (2023) :112-119.
19. Olieviera SA., et al. “Final Oocyte Maturation in Assisted Reproduction with Human Chorionic Gonadotropin and Gonadotropin-releasing Hormone agonist (Dual Trigger)”. JBRA Assistant Reproduction 20 (2016): 246-250.

Citation

Citation: Kulvinder Kochar Kaur., et al. “An Innovative Approach of HCG Trigger with Concurrent 1500 IU HCG and 450 IU FSH Utilization for OHSS Avoidance in High Risk Patients - Is it Superior to Dual Trigger".Acta Scientific Women's Health 5.11 (2023): 08-11.

Copyright

Copyright: © 2023 Kulvinder Kochar Kaur., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.