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Agonist triggering in controlled ovarian stimulation protocols is being used during last years (among high responder patients to avoid OHSS).
Indeed, agonist triggering is more physiologic than HCG triggering. Investigators propose to compare the effectiveness of both types of trigger among three different subsets of patients:
During the last years, ovulation triggering in controlled ovarian stimulation protocols has been used specially to avoid hyperstimulation syndromes (OHSS). Indeed, the substitution of the classical HCG triggering by the agonist one, reduces almost to zero the risk of OHSS.
On the other hand poor responder patients to ovarian stimulation represent a challenge in assisted reproduction. Defining poor responders is not easy, but we can define them as those patients with less than 4 eggs obtained after oocyte retrieval.
Different strategies have been proposed to overcome this problem. In other words, to obtain more oocytes. These include an increase in FSH doses, an increase in FSH action by adding sensitizers agents.
Among the possible strategies, investigators propose the agonist triggering. HCG (classical) triggering represents the use of a LH-like product (with a prolonged action). The administration of a GnRH agonist provoke the production and liberation of both FSH and LH. Thus, the pro-ovulatory action is more physiologic , and possibly, more effective.
So, the use of a triggering protocol that nowadays is being used among high responders (thus reducing the OHSS risk) is proposed for both poor responder and normo-responder patients trying to achieve more oocytes, and specifically more mature oocytes.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Poor responders. Classical trigger | Active Comparator | Intervention: HCG trigger (Administration of recombinant HCG 250 UI subcutaneously 36 prior to oocyte retrieval. Women scheduled for IVF treatment with 4 or less antral follicles in ultrasound assessment. |
|
| Poor responders. Agonist trigger | Experimental | Intervention: Agonist trigger (administration of 0,2 mg of Triptoreline subcutaneously 36 hours prior to oocyte retrieval) Women scheduled for IVF treatment with 4 or less antral follicles in ultrasound assessment. |
|
| Normo responders. Classical trigger | Active Comparator | Intervention: HCG trigger (Administration of recombinant HCG 250 UI subcutaneously 36 prior to oocyte retrieval. Women scheduled for IVF treatment with more than 4 and less than 16 antral follicles in ultrasound assessment. |
|
| Normo responders. Agonist trigger | Experimental | Intervention: Agonist trigger (administration of 0,2 mg of Triptoreline subcutaneously 36 hours prior to oocyte retrieval) Women scheduled for IVF treatment with more than 4 and less than 16 antral follicles in ultrasound assessment. |
|
| High responders. Classical trigger |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Gonadotropin Releasing Hormone Agonists (GNRH-A) | Drug | Administration of a gonadotropin releasing hormone agonist (GnRH-a) (0,2 ml) subcutaneously, 36 hours before ovum pick-up in IVF treatments. |
| Measure | Description | Time Frame |
|---|---|---|
| Mature oocytes | Number of mature oocytes achieved after oocyte retrieval. | Up to 24 weeks |
| Measure | Description | Time Frame |
|---|---|---|
| Relation mature oocytes/punctured oocytes | Relation between the number of mature oocytes and the follicles. | Up to 24 weeks |
| Fertilized oocytes | Number of fertilized oocytes |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Gorka Barrenetxea, PhD | Contact | 00 34 605711484 | gbarrenetxea@reproduccionbilbao.es | |
| Amaia Garcia, PhD | Contact | agarcia@reproduccionbilbao.es |
| Name | Affiliation | Role |
|---|---|---|
| Gorka Barrenetxea, PhD | Reproducción Bilbao. Universidad del PaÃs Vasco/Euskal Herriko Unibertsitatea | Principal Investigator |
| Jon Iker Arambarri, MD | Reproducción Bilbao. Universidad del PaÃs Vasco/Euskal Herriko Unibertsitatea |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Reproduccion Bilbao Assisted Reproduction Center | Bilbao | Bizkaia | 48014 | Spain |
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| ID | Term |
|---|---|
| D007247 | Infertility, Female |
| ID | Term |
|---|---|
| D005831 | Genital Diseases, Female |
| D052776 | Female Urogenital Diseases |
| D005261 | Female Urogenital Diseases and Pregnancy Complications |
| D000091642 | Urogenital Diseases |
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| ID | Term |
|---|---|
| D006063 | Chorionic Gonadotropin |
| ID | Term |
|---|---|
| D006062 | Gonadotropins |
| D036361 | Peptide Hormones |
| D006728 | Hormones |
| D006730 | Hormones, Hormone Substitutes, and Hormone Antagonists |
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IVF patients enrolled either to HCG or agonist trigger ovulation induction
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| Active Comparator |
Intervention: HCG trigger (Administration of recombinant HCG 250 UI subcutaneously 36 prior to oocyte retrieval. Women scheduled for IVF treatment with more than 15 antral follicles in ultrasound assessment. |
|
| High responders. Agonist trigger | Experimental | Intervention: Agonist trigger (administration of 0,2 mg of Triptoreline subcutaneously 36 hours prior to oocyte retrieval) Women scheduled for IVF treatment with more than 15 antral follicles in ultrasound assessment. |
|
|
| Human chorionic gonadotropin | Drug | Administration of Human chorionic gonadotropin (HCG) 250 IU subcutaneously , 36 hours before ovum pick-up in IVF treatments. |
|
|
| Up to 24 weeks |
| Relation fertilized oocytes/achieved Mature oocytes | Relation between the number of fertilized oocytes and the mature oocytes achieved. | Up to 24 weeks |
| Number of blastocysts developed | Number of blastocysts developed in each arm of the study. | Up to 24 weeks |
| Cancelled cycles | Percentage of cancelled cycles | Up to 24 weeks |
| D000091662 | Genital Diseases |
| D007246 | Infertility |
| D010926 | Placental Hormones |
| D010455 | Peptides |
| D000602 | Amino Acids, Peptides, and Proteins |
| D011257 | Pregnancy Proteins |
| D011506 | Proteins |