Gonadotropin-releasing hormone agonist versus HCG for oocyte triggering in antagonist assisted reproductive technology cycles.

BACKGROUND: Gonadotropin-releasing hormone (GnRH) antagonist protocols for pituitary down regulation in in vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI) allow the use of GnRH agonists for triggering final oocyte maturation. Currently, human chorionic gonadotropin (HCG) is still the standard medication for this purpose. The effectiveness of triggering with a GnRH agonist compared to HCG measured as pregnancy and ovarian hyperstimulation(OHSS) rates are unknown. OBJECTIVES: To compare the effectiveness of a GnRH agonist with HCG for triggering final oocyte maturation in IVF and ICSI patients undergoing controlled ovarian hyperstimulation in a GnRH antagonist protocol followed by embryo transfer.  SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE , EMBASE, the National Research Register, the Medical Research Council's Clinical Trials Register, and the NHS Centre for Reviews and Dissemination database. We also examined the reference lists of all known primary studies and review articles, citation lists of relevant publications and abstracts of major scientific meetings. SELECTION CRITERIA: All randomised controlled studies (RCTs) reporting data comparing clinical outcomes for women undergoing IVF and ICSI cycles and using a GnRH agonist in comparison with HCG for final oocyte maturation triggering. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trial quality and extracted data. MAIN RESULTS: We identified 11 RCTs (n = 1055). Eight studies assessed fresh autologous cycles and three studies assessed donor-recipient cycles. In fresh-autologous cycles, GnRH agonist was less effective than HCG in terms of the live birth rate per randomised woman (OR 0.44, 95% CI 0.29 to 0.68; 4 RCTs) and ongoing pregnancy rate per randomised woman (OR 0.45, 95% CI 0.31 to 0.65; 8 RCTs). For a group with a 30% live birth or ongoing pregnancy rate using HCG, the rate would be between 12% and 22% using an GnRH agonist. Moderate to severe ovarian hyperstimulation syndrome (OHSS) incidence per randomised woman was significantly lower in the GnRH agonist group compared to the HCG group (OR 0.10, 95% CI 0.01 to 0.82; 5 RCTs). For a group with a 3% OHSS rate using HCG the rate would be between 0% and 2.6% using GnRH agonist. In donor recipient cycles, there was no evidence of a statistical difference in the live birth rate per randomised woman (OR 0.92, 95% CI 0.53 to 1.61; 1 RCT). AUTHORS' CONCLUSIONS: We do not recommend that GnRH agonists be routinely used as a final oocyte maturation trigger in fresh autologous cycles because of lowered live birth rates and ongoing pregnancy rates. An exception could be made for women with high risk of OHSS, after appropriate counselling.

Non-mosaic Klinefelter syndrome and successful testicular sperm extraction-intracytoplasmic sperm injection procedure: case report.

INTRODUCTION: Klinefelter syndrome is the commonest chromosomal cause of non-obstructive azoospermia. Despite reports that these men can have children using assisted reproduction techniques, it is not common practice in the Egypt to offer sperm retrieval to these men. DESIGN: Case report. SETTING: Private IVF center (EIFC-IVF) and a university hospital. PATIENT: A 24-year-old woman and a 29-year-old man with non-mosaic Klinefelter syndrome. INTERVENTION: Testicular sperm extraction followed by intracytoplasmic sperm injection and embryo transfer (TESE-ICSI). RESULTS: Fifteen immotile sperms were found, five oocytes were injected, and three embryos were transferred. Now the pregnancy is progressing beyond 20 weeks. CONCLUSION: Spermatozoa from a patient with non-mosaic Klinefelter syndrome retrieved through TESE can lead to pregnancy.

Cervical twin ectopic pregnancy after in vitro fertilization-embryo transfer (IVF-ET): case report.

INTRODUCTION: Cervical twin ectopic pregnancy after IVF-ET is rare and catastrophic complication. However, here is no consensus on the best treatment strategy. PATIENT AND METHOD: Case report of cervical twin ectopic pregnancy after IVF-ET treated by transvaginal ultrasound guided aspiration plus systemic single injection of methotrexate, which followed by full-term delivery in next IVF-ET cycle. CONCLUSION: Transvaginal ultrasound-guided aspiration and systemic methotrexate administration can be safely and easily used to treat cervical ectopic pregnancies and to preserve the fertility of the patient without any major complications.