Prevention of Premature Ovulation by Administration of Gonadotropin Releasing Hormone Antagonist the day After Ovulation Triggering in Diminished Ovarian Reserve Patients.

Objective:  The aim of the present retrospective study was to investigate the effectiveness of single-dose gonadotropin releasing hormone (GnRH) antagonist administration, the day after human chorionic gonadotropin (hCG) triggering for final oocyte maturation, on the prevention of premature luteinization in patients with diminished ovarian reserve in in-vitro fertilization (IVF) cycles. The secondary objective of the study was to search the effect of this protocol on pregnancy outcomes.

Methods:  This is a retrospective study including 267 infertile patients who have single antral follicle seen with ultrasonography on the 2 or 3 day of the menstrual cycle before starting IVF treatment. We randomized patients into two groups. The case group comprised patients who had single-dose GnRH antagonist injection the day after hCG triggering formed, and the patients who had the standard treatment regime formed the control group. In both groups, the oocytes were collected 36 hours after hCG injection.

Results:  The premature ovulation rate was significantly low in the case group compared with the control group (6.86 versus 20.6% per scheduled cycle) ( = 0.022). Also, the oocyte retrieval rate (93.14 versus 67.87% per scheduled cycle) ( = 0.013), the oocyte maturity rate (79.42 47.87%) ( = 0.041), the fertilization rate (65.68 34.54%) ( = 0.018), and the embryo transfer rate per scheduled cycle (44.11 versus 18.78%) ( = 0.003) were higher in the GnRH antagonist group than in the control group.

Conclusion:  The administration of GnRH antagonist the day after hCG trigger in IVF treatments of patients with diminished ovarian reserve enabled a significant decrease in the rate of premature ovulation but had no effect on live birth rate.