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CC BY 4.0 · Rev Bras Ginecol Obstet 2022; 44(04): 369-375
DOI: 10.1055/s-0041-1741455
Original Article
Human Reproduction and Assisted Fertilization

Use of Triggers on in vitro Fertilization and Evaluation of Risk Factors for Sub-Optimal Maturation Rate

Uso de gatilhos na fertilização in vitro e avaliação dos fatores de risco para taxa de maturação subótima
Larissa Matsumoto 
1   Department of Human Reproduction, VidaBemVinda Human Reproduction Care Center, São Paulo, SP, Brazil
,
Lucas Yugo Shiguerhara Yamakami 
1   Department of Human Reproduction, VidaBemVinda Human Reproduction Care Center, São Paulo, SP, Brazil
,
Edson Guimarães Lo Turco 
2   Department of Human Reproduction, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
,
Cristina Laguna Benetti-Pinto 
3   Department of Gynecology and Obstetrics, Faculty Medical Sciences, Universidade Estadual de Campinas, Campinas, SP, Brazil
,
Daniela Angerame Yela 
3   Department of Gynecology and Obstetrics, Faculty Medical Sciences, Universidade Estadual de Campinas, Campinas, SP, Brazil
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Abstract

Objective To compare the oocyte maturation rate in the treatment of in vitro fertilization (IVF) in terms of the use of human chorionic gonadotropin (hCG), agonist gonadotropin-releasing hormone (GnRH) and dual trigger and to evaluate the associated risk factors for sub-optimal maturation rates.

Methods A retrospective cohort study with 856 women who underwent IVF. They performed oocyte retrieval and were classified into 3 groups (1 - hCG, 2 - GnRH agonist, 3 - dual trigger). The primary outcome was maturation rate per trigger, and the secondary outcomes were the pregnancy rate per oocyte retrieval and the correlations between low maturation rate as well as the clinical and treatment characteristics of women.

Results The maturation rate was 77% in group 1; 76% in group 2, and 83% in group 3 (p = 0.003). Group 2 showed women with better ovarian reserve, greater number of oocytes collected, and more mature oocytes and embryos compared with the other groups (p < 0.001). The cumulative clinical pregnancy rate was no different between the groups (p = 0.755). Low ovarian reserve and low doses of follicle-stimulating hormone (FSH) administered during the stimulus were associated with a higher chance of null maturation rate.

Conclusion The oocyte maturation rates and IVF results were similar in all groups. Low ovarian reserve is associated with the worst treatment results.

Resumo

Objetivo Comparar a taxa de maturação oocitária no tratamento de fertilização in vitro (FIV) em relação so o uso de gonadotrofina coriônica humana (hCG), agonista de hormônio liberador de gonadotrofina (GnRH), e gatilho duplo e avaliar os fatores de risco associados a taxas de maturação subótimas.

Métodos Estudo de coorte retrospectivo com 856 mulheres submetidas à FIV. Elas foram classificadas em 3 grupos (1 - hCG, 2 - GnRH agonista, 3 - gatilho duplo). O desfecho primário foi a taxa de maturação por gatilho, e os desfechos secundários foram a taxa de gravidez por recuperação de oócitos e as correlações entre a baixa taxa de maturação bem como as características clínicas e do tratamento das mulheres.

Resultados A taxa de maturação foi de 77% no grupo 1; 76% no grupo 2, e 83% no grupo 3 (p = 0,003). O grupo 2 apresentou mulheres com melhor reserva ovariana, maior número de oócitos coletados, oócitos maduros, e embriões, em comparação aos demais grupos (p < 0,001). A taxa cumulativa de gravidez clínica não foi diferente entre os grupos (p = 0,755). Baixa reserva ovariana e baixas doses de hormônio folículo-estimulante (FSH) administradas durante o estímulo foram associadas a uma maior chance de taxa de maturação nula.

Conclusão As taxas de maturação oocitárias e os resultados de FIV foram semelhantes em todos os grupos. A baixa reserva ovariana está associada aos piores resultados do tratamento.

Keywords

dual trigger - GnRH agonist - HCG in vitro fertilization - oocyte maturation

Palavras-chave

gatilho duplo - agonista de GnRH - HCG fertilização in vitro - maturação oocitária

Contributions

All the authors participated actively in the study, as follows: D. A. Yela and C. L. Benetti-Pinto were responsible for writing the protocol and the final manuscript. L. Matsumoto, E. G. lo Turco. and L. Y. S. Yamakami collected the data and conducted the literature review.




Publication History

Received: 07 September 2020

Accepted: 05 October 2021

Article published online:
02 February 2022

© 2022. Federação Brasileira de Ginecologia e Obstetrícia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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