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Adjuvant gonadotrophin-releasing hormone agonist trigger with human chorionic gonadotrophin to enhance ooplasmic maturity
The results suggest that combined GnRHa and HCG trigger in ICSI cycles is a reasonable approach to increase oocyte maturity, specifically ooplasmic maturity, thereby increasing fertilization and improving ICSI cycle outcomes in patients with a history of poor fertilization after standard HCG trigger alone.
www.rbmojournal.com/article/S1472-6483(16)30457-6/fulltext
197. GnRHa and hCG improves the outcome of cases with previous poor ICSI fertilisation. [Forum/Discussion]
from: James Stanger (office@fertaid.com ), Australia on 2/09/2016 9:19:22 AM Profession:
Comment: The use of a dual trigger for cases with poor ICSI fetilisation is a good treatment option.
Submission Poor fertilisation after ICSI is a relatively low occurrence since most oocytes are mature (with polar body) at injection. Where the rates are low (<40%), doubts are usually directed toward sperm quality (or the whole culture system). This article suggested that oocyte cytoplasmic maturation may be an issue and by inducing ovulation with both hCG (LH receptor) and GnRHa (both LH and FSH receptors) stimulation improves oocyte yield, fertilisation and pregnancy.
For clinicians, having an alternative treatment option for the next cycle is always good to have at hand. In this case, it may also improve the chance of pregnancy.
Whether the GnRHa co-ovulation tool improves cytoplasimic maturation ( for example, think sperm derived lipase C and calcium oscillations after fertilisation), a role for FSH at ovulation (what happens during normal ovulation) or a deceased sensitivity of the LH receptors to hCG, the article reminds us that all IVF centers around the ovulation process but is one that almost all take for granted. It would be interesting to see a followup paper on this topic to see what proportion of poor ICSI fertilisations may respond to this treatment.
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