Gonadotropin-releasing hormone agonist trigger in oocyte donors co-treated with a gonadotropin-releasing hormone antagonist: a dose-finding study

Objective: To determine the optimal GnRH agonist dose for triggering of oocyte maturation in oocyte donors. Design: Single-center, randomized, parallel, investigator-blinded trial. Setting: IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam. Patient(s): One hundred sixty-five oocyte donors (aged 18-35 years, body mass index [BMI] <28 kg/m(2), antimullerian hormone level >1.25 ng/mL, and antral follicle count >= 6). Intervention(s): Ovulation trigger with 0.2, 0.3, or 0.4 mg triptorelin in a GnRH antagonist cycle. Main Outcome Measure(s): The primary end point was number of metaphase II oocytes. Secondary end points were fertilization and cleavage rates, number of embryos and top-quality embryos, steroid levels, ovarian volume, and ongoing pregnancy rate (PR) in recipients. Result(s): There were no significant differences between the triptorelin 0.2, 0.3, and 0.4 mg trigger groups with respect to number of metaphase II oocytes (16.0 +/- 8.5, 15.9 +/- 7.8, and 14.7 +/- 8.4, respectively), embryos (13.2 +/- 7.8, 11.7 +/- 6.9, 11.8 +/- 7.0), and number of top-quality embryos (3.8 +/- 2.9, 3.6 +/- 3.0, 4.1 +/- 3.0). Luteinizing hormone levels at 24 hours and 36 hours after trigger was significantly higher with triptorelin 0.4 mg versus 0.2 mg and 0.3 mg (9.8 +/- 7.1 IU/L vs. 7.3 +/- 4.1 IU/L and 7.2 +/- 3.7 IU/L, respectively; 4.6 +/- 3.2 IU/L vs. 3.2 +/- 2.3 IU/L and 3.3 +/- 2.1 IU/L, respectively. Progesterone level at oocyte pick-up +6 days was significantly higher in the 0.4-mg group (2.2 +/- 3.7 ng/ml) versus 0.2 mg (1.1 +/- 1.0 ng/ml) and 0.3 mg (1.2 +/- 1.6 ng/ml). One patient developed early-onset severe ovarian hyperstimulation syndrome (OHSS). Conclusion(s): No significant differences between triptorelin doses of 0.2, 0.3, and 0.4 mg used for ovulation trigger in oocyte donors were seen with regard to the number of mature oocytes and top-quality embryos. (C) 2016 by American Society for Reproductive Medicine.