Abstract

The introduction of gonadotrophin-releasing hormone agonist (GnRHa) trigger greatly impacted modern IVF treatment. Patients at low risk of ovarian hyperstimulation syndrome (OHSS) development, undergoing fresh embryo transfer and GnRHa trigger can be offered a virtually OHSS-free treatment with non-inferior reproductive outcomes by using a modified luteal phase support in terms of small boluses of human chorionic gonadotrophin (hCG), daily recombinant luteinizing hormone LH (rLH) or GnRHa. In the OHSS risk patient, GnRHa trigger can safely be performed, followed by a ‘freeze-all’ policy with a minimal risk of OHSS development and high live birth rates in the subsequent frozen embryo transfer cycle. Importantly, GnRHa trigger opened the ‘black box’ of the luteal phase, promoting research in the most optimal steroid levels during the luteal phase. GnRHa trigger allows high-dose gonadotropin stimulation to achieve the optimal number of oocytes and embryos needed to ensure the highest chance of live birth. This review thoroughly discusses how the GnRHa trigger concept adds safety and efficacy to modern IVF in terms of OHSS prevention. Furthermore, the optimal luteal phase management after GnRHa trigger in fresh embryo transfer cycles is discussed.

摘要

促性腺激素释放激素激动剂（GnRHa）的引入极大地影响了现代IVF治疗。卵巢超刺激综合征（OHSS）发生风险低，正在接受新鲜胚胎移植和GnRHa触发的患者可以通过使用小剂量人绒毛膜促性腺激素改良的黄体期支持剂，获得几乎无OHSS的治疗，且无不良的生殖结果促性腺激素（hCG），每日重组促黄体生成激素LH（rLH）或GnRHa。对于有OHSS风险的患者，可以安全地执行GnRHa触发，然后执行“冻结所有”策略，在随后的冷冻胚胎移植周期中，将OHSS发生的风险降至最低，并提高活产率。重要的是，GnRHa触发器打开了黄体期的“黑匣子”，从而促进了黄体期最佳类固醇水平的研究。GnRHa触发器可刺激大剂量促性腺激素，以达到确保活产的最高机会所需的卵母细胞和胚胎的最佳数量。这篇综述彻底讨论了GnRHa触发概念如何从OHSS预防的角度为现代IVF增加安全性和功效。此外，讨论了新鲜胚胎移植周期中GnRHa触发后的最佳黄体期管理。