Skip to main content
SpringerLink
Log in

Failure of GnRH agonist-triggered oocyte maturation: its cause and management

  • ASSISTED REPRODUCTION TECHNOLOGIES
  • Published:
Journal of Assisted Reproduction and Genetics Aims and scope Submit manuscript

Abstract

Objective

In the present study we investigated the cause of GnRHa’s failure to trigger oocyte maturation and present an effective rescue protocol for use when failure occurs.

Design

Case reports.

Setting

One in vitro fertilization (IVF) center.

Patient(s)

Eight cases of failure of GnRH agonist (GnRHa)-triggered oocyte maturation and one case of GnRHa successfully triggered oocyte maturation, despite a weak response in the LH-RH test.

Main Outcome Measure(s)

All cases were successfully rescued by re-triggering maturation using HCG, with seven of the eight patients achieving ongoing pregnancy and successful delivery.

Result(s)

In three patients the cause of the oocyte maturation failure was likely temporal or continuous severe down-regulation of the hypothalamus-pituitary-axis, the cause was unknown in the other five patients.

Conclusion(s)

In cases where GnRHa fails to trigger oocyte maturation, a rescue protocol entailing re-triggering with HCG can produce successful outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

References

  1. Aboulghar M. Symposium: update on prediction and management of OHSS. Prevention of OHSS. Reprod Biomed Online. 2009;19:33–42.

    Article  PubMed  CAS  Google Scholar 

  2. Engmann L, Siano L, Schmidt D, Nulsen J, Maier D, Benadiva C. GnRH agonist to induce oocyte maturation during IVF in patients at high risk of OHSS. Reprod Biomed Online. 2006;13:639–44.

    Article  PubMed  CAS  Google Scholar 

  3. Humaidan P, Quartarolo J, Papanikolaou EG. Preventing ovarian hyperstimulation syndrome: guidance for the clinician. Fertil Steril. 2010;94:389–400.

    Article  PubMed  Google Scholar 

  4. Humaidan P, Bredkjaer HE, Bungum L, Bungum M, Grondahl ML, Westergaard L, et al. GnRH agonist (buserelin) or hCG for ovulation induction in GnRH antagonist IVF/ICSI cycles: a prospective randomized study. Hum Reprod. 2005;20:1213–20.

    Article  PubMed  CAS  Google Scholar 

  5. Chen SL, Ye DS, Chen X, Yang XH, Zheng HY, Tang Y, et al. Circulating luteinizing hormone level after triggering oocyte maturation with GnRH agonist may predict oocyte yield in flexible GnRH antagonist protocol. Hum Reprod. 2012;27:1351–6.

    Article  PubMed  CAS  Google Scholar 

  6. Honnma H, Hashiba Y, Asada Y, Endo T. Failure of triggering oocyte maturation with a GnRH agonist in polycystic ovary syndrome: two case reports. Eur J Obstet Gynecol Reprod Biol. 2011;157:239–40.

    Article  PubMed  Google Scholar 

  7. Stevenson TL, Lashen H. Empty follicle syndrome: the reality of a controversial syndrome, a systematic review. Fertil Steril. 2008;90:691–8.

    Article  PubMed  Google Scholar 

  8. Honnma H, Baba T, Sasaki M, Hashiba Y, Ohno H, Fukunaga T, et al. Trophectoderm morphology significantly affects the rates of ongoing pregnancy and miscarriage in frozen-thawed single-blastocyst transfer cycle in vitro fertilization. Fertil Steril. 2012;98:361–7.

    Article  PubMed  Google Scholar 

  9. Peluso JJ. Role of the amplitude of the gonadotropin surge in the rat. Fertil Steril. 1990;53:150–4.

    PubMed  CAS  Google Scholar 

  10. Castillo JC, Garcia-Velasco J, Humaidan P. Empty follicle syndrome after GnRHa triggering versus hCG triggering in COS. J Assist Reprod Genet. 2012;29:249–53.

    Article  PubMed  Google Scholar 

  11. Tomazevic T, Meden-Vrtovec H. Early timed follicular aspiration prevents severe ovarian hyperstimulation syndrome. J Assist Reprod Genet. 1996;13:282–6.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgment

None of the authors have a conflict of interest. We thank the nursing and embryology staffs of the Asada Ladies Clinic for their expert technical help.

Author information

Authors and Affiliations

  1. Asada Ladies Clinic, RENAK 5F, Matsushincho 1-4, Kasugai, Aichi, 486-0931, Japan

    Yoshimasa Asada, Fumiaki Itoi, Hiroyuki Honnma, Shuji Takiguchi, Noritaka Fukunaga & Yoshiki Hashiba

  2. Department of OB & GY, Sapporo Medical University School of Medicine, South 1 West 16, Chuo-ku, Sapporo, 060-8543, Japan

    Tsuyoshi Baba & Toshiaki Endo

Authors
  1. Yoshimasa Asada
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Fumiaki Itoi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hiroyuki Honnma
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shuji Takiguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Noritaka Fukunaga
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yoshiki Hashiba
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Tsuyoshi Baba
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Toshiaki Endo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hiroyuki Honnma.

Additional information

Authors’ contributions

YA participated in the study as project supervisor coordinator overseeing the critical revision of the manuscript. FI carried out the bibliographic research. HH conceived the study and the design and drafted the manuscript. ST and YH helped draft the manuscript. NF, TB and TE analyzed the results. All authors read and approved the final manuscript.

Capsule

In cases where GnRHa fails to trigger oocyte maturation, a rescue protocol entailing re-triggering with HCG can produce successful outcomes.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Asada, Y., Itoi, F., Honnma, H. et al. Failure of GnRH agonist-triggered oocyte maturation: its cause and management. J Assist Reprod Genet 30, 581–585 (2013). https://doi.org/10.1007/s10815-013-9966-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10815-013-9966-4

Keywords

Search

Navigation