Abstract：
OBJECTIVE: What are the potential risk factors for poor oocyte recuperation rate (ORR) and oocyte immaturity after GnRH agonist (GnRHa) ovulation triggering?
CONCLUSIONS: Lower ovarian reserve and LH levels after GnRHa triggering are risk factors of poor ORR. Higher BMI and anti-Müllerian hormone (AMH) levels are risk factors of poor oocyte maturation rate (OMR).
BACKGROUND: The use of GnRHa to trigger ovulation is increasing. However, some patients may have a suboptimal response after GnRHa triggering. This suboptimal response can refer to any negative endpoint, such as suboptimal oocyte recovery, oocyte immaturity, or empty follicle syndrome. For some authors, a suboptimal response to GnRHa triggering refers to a suboptimal LH and/or progesterone level following triggering. Several studies have investigated a combination of demographic, clinical, and endocrine characteristics at different stages of the treatment process that may affect the efficacy of the GnRHa trigger and thus be involved in a poor endocrine response or efficiency but no consensus exists.
METHODS: Bicentric retrospective cohort study between 2015 and 2021 (N = 1747).
METHODS: All patients aged 18-43 years who underwent controlled ovarian hyperstimulation and ovulation triggering by GnRHa alone (triptorelin 0.2 mg) for ICSI or oocyte cryopreservation were included. The ORR was defined as the ratio of the total number of retrieved oocytes to the number of follicles >12 mm on the day of triggering. The OMR was defined as the ratio of the number of mature oocytes to the number of retrieved oocytes. A logistic regression model with a backward selection method was used for the analysis of risk factors. Odds ratios (OR) are displayed with their two-sided 95% confidence interval.
RESULTS: In the multivariate analysis, initial antral follicular count and LH level 12-h post-triggering were negatively associated with poor ORR (i.e. below the 10th percentile) (OR: 0.61 [95% CI: 0.42-0.88]; P = 0.008 and OR: 0.86 [95% CI: 0.76-0.97]; P = 0.02, respectively). A nonlinear relationship was found between LH level 12-h post-triggering and poor ORR, but no LH threshold was found. A total of 25.3% of patients suffered from oocyte immaturity (i.e. OMR < 75%). In the multivariate analysis, BMI and AMH levels were negatively associated with an OMR < 75% (OR: 4.34 [95% CI: 1.96-9.6]; P < 0.001 and OR: 1.22 [95% CI: 1.03-1.12]; P = 0.015, respectively). Antigonadotrophic pretreatment decreased the risk of OMR < 75% compared to no pretreatment (OR: 0.72 [95% CI: 0.57-0.91]; P = 0.02).
CONCLUSIONS: Our study is limited by its retrospective design and by the exclusion of patients who had hCG retriggers. However, this occurred in only six cycles. We were also not able to collect information on the duration of pretreatment and the duration of wash out period.
CONCLUSIONS: In clinical practice, to avoid poor ORR, GnRHa trigger alone should not be considered in patients with higher BMI and/or low ovarian reserve, balanced by the risk of ovarian hyperstimulation syndrome. In the case of a low 12-h post-triggering LH level, practicians must be aware of the risk of poor ORR, and hCG retriggering could be considered.
BACKGROUND: None.
BACKGROUND: N/A.
CONCLUSIONS: Lower ovarian reserve and LH levels after GnRHa triggering are risk factors of poor ORR. Higher BMI and anti-Müllerian hormone (AMH) levels are risk factors of poor oocyte maturation rate (OMR).
BACKGROUND: The use of GnRHa to trigger ovulation is increasing. However, some patients may have a suboptimal response after GnRHa triggering. This suboptimal response can refer to any negative endpoint, such as suboptimal oocyte recovery, oocyte immaturity, or empty follicle syndrome. For some authors, a suboptimal response to GnRHa triggering refers to a suboptimal LH and/or progesterone level following triggering. Several studies have investigated a combination of demographic, clinical, and endocrine characteristics at different stages of the treatment process that may affect the efficacy of the GnRHa trigger and thus be involved in a poor endocrine response or efficiency but no consensus exists.
METHODS: Bicentric retrospective cohort study between 2015 and 2021 (N = 1747).
METHODS: All patients aged 18-43 years who underwent controlled ovarian hyperstimulation and ovulation triggering by GnRHa alone (triptorelin 0.2 mg) for ICSI or oocyte cryopreservation were included. The ORR was defined as the ratio of the total number of retrieved oocytes to the number of follicles >12 mm on the day of triggering. The OMR was defined as the ratio of the number of mature oocytes to the number of retrieved oocytes. A logistic regression model with a backward selection method was used for the analysis of risk factors. Odds ratios (OR) are displayed with their two-sided 95% confidence interval.
RESULTS: In the multivariate analysis, initial antral follicular count and LH level 12-h post-triggering were negatively associated with poor ORR (i.e. below the 10th percentile) (OR: 0.61 [95% CI: 0.42-0.88]; P = 0.008 and OR: 0.86 [95% CI: 0.76-0.97]; P = 0.02, respectively). A nonlinear relationship was found between LH level 12-h post-triggering and poor ORR, but no LH threshold was found. A total of 25.3% of patients suffered from oocyte immaturity (i.e. OMR < 75%). In the multivariate analysis, BMI and AMH levels were negatively associated with an OMR < 75% (OR: 4.34 [95% CI: 1.96-9.6]; P < 0.001 and OR: 1.22 [95% CI: 1.03-1.12]; P = 0.015, respectively). Antigonadotrophic pretreatment decreased the risk of OMR < 75% compared to no pretreatment (OR: 0.72 [95% CI: 0.57-0.91]; P = 0.02).
CONCLUSIONS: Our study is limited by its retrospective design and by the exclusion of patients who had hCG retriggers. However, this occurred in only six cycles. We were also not able to collect information on the duration of pretreatment and the duration of wash out period.
CONCLUSIONS: In clinical practice, to avoid poor ORR, GnRHa trigger alone should not be considered in patients with higher BMI and/or low ovarian reserve, balanced by the risk of ovarian hyperstimulation syndrome. In the case of a low 12-h post-triggering LH level, practicians must be aware of the risk of poor ORR, and hCG retriggering could be considered.
BACKGROUND: None.
BACKGROUND: N/A.
摘要：
目的：促性腺激素释放激素激动剂（GnRHa）排卵后，卵母细胞恢复率（ORR）差和卵母细胞不成熟的潜在危险因素是什么？
结论：促性腺激素释放激素激动剂（GnRHa）触发后卵巢储备功能降低和LH水平是ORR差的危险因素。较高的BMI和抗苗勒管激素（AMH）水平是卵母细胞成熟率（OMR）低下的危险因素。
背景：使用GnRHa引发排卵的情况正在增加。然而,一些患者在GnRHa触发后可能出现不良反应.这种次优响应可以指任何负终点，例如卵母细胞恢复不理想，卵母细胞不成熟,或者空卵泡综合征.对于一些作者来说，对GnRHa触发的次优反应是指触发后LH和/或孕酮水平次优。几项研究调查了人口统计学的组合，临床,和内分泌特征在治疗过程的不同阶段，可能会影响GnRHa触发剂的疗效，因此涉及不良的内分泌反应或效率，但没有共识存在。
方法：2015年至2021年的双中心回顾性队列研究（N=1747）。
方法：纳入所有18-43岁接受控制性超促排卵和单独使用GnRHa（曲普瑞林0.2mg）进行ICSI或卵母细胞冷冻保存的排卵触发的患者。ORR定义为在触发当天回收的卵母细胞总数与>12mm的卵泡数的比率。OMR定义为成熟卵母细胞的数量与回收的卵母细胞的数量的比率。采用后向选择方法的logistic回归模型进行危险因素分析。赔率比(OR)以其双侧95%置信区间显示。
结果：在多变量分析中，触发后12小时的初始窦卵泡计数和LH水平与ORR不良(即低于第10百分位数)呈负相关(OR:0.61[95%CI:0.42-0.88];P=0.008和OR:0.86[95%CI:0.76-0.97];P=0.02,分别).在触发后12小时的LH水平与不良ORR之间发现了非线性关系，但未发现LH阈值。总共25.3%的患者患有卵母细胞不成熟(即OMR<75%)。在多变量分析中，BMI和AMH水平与OMR<75％呈负相关（OR：4.34[95％CI：1.96-9.6]；P<0.001和OR：1.22[95％CI：1.03-1.12]；P=0.015，分别）。与无预处理相比，抗促性腺激素预处理降低了OMR<75％的风险（OR：0.72[95％CI：0.57-0.91]；P=0.02）。
结论：我们的研究受到回顾性设计和排除hCG再触发者的限制。然而,这只发生在六个周期中。我们也无法收集有关预处理持续时间和冲洗期持续时间的信息。
结论：在临床实践中，为了避免糟糕的ORR，在BMI较高和/或卵巢储备较低的患者中，不应仅考虑GnRHa触发。与卵巢过度刺激综合征的风险平衡。在低的12小时后触发LH水平的情况下，执业医师必须意识到ORR不良的风险，可以考虑重新触发hCG。
背景：无。
背景：不适用。
结论：促性腺激素释放激素激动剂（GnRHa）触发后卵巢储备功能降低和LH水平是ORR差的危险因素。较高的BMI和抗苗勒管激素（AMH）水平是卵母细胞成熟率（OMR）低下的危险因素。
背景：使用GnRHa引发排卵的情况正在增加。然而,一些患者在GnRHa触发后可能出现不良反应.这种次优响应可以指任何负终点，例如卵母细胞恢复不理想，卵母细胞不成熟,或者空卵泡综合征.对于一些作者来说，对GnRHa触发的次优反应是指触发后LH和/或孕酮水平次优。几项研究调查了人口统计学的组合，临床,和内分泌特征在治疗过程的不同阶段，可能会影响GnRHa触发剂的疗效，因此涉及不良的内分泌反应或效率，但没有共识存在。
方法：2015年至2021年的双中心回顾性队列研究（N=1747）。
方法：纳入所有18-43岁接受控制性超促排卵和单独使用GnRHa（曲普瑞林0.2mg）进行ICSI或卵母细胞冷冻保存的排卵触发的患者。ORR定义为在触发当天回收的卵母细胞总数与>12mm的卵泡数的比率。OMR定义为成熟卵母细胞的数量与回收的卵母细胞的数量的比率。采用后向选择方法的logistic回归模型进行危险因素分析。赔率比(OR)以其双侧95%置信区间显示。
结果：在多变量分析中，触发后12小时的初始窦卵泡计数和LH水平与ORR不良(即低于第10百分位数)呈负相关(OR:0.61[95%CI:0.42-0.88];P=0.008和OR:0.86[95%CI:0.76-0.97];P=0.02,分别).在触发后12小时的LH水平与不良ORR之间发现了非线性关系，但未发现LH阈值。总共25.3%的患者患有卵母细胞不成熟(即OMR<75%)。在多变量分析中，BMI和AMH水平与OMR<75％呈负相关（OR：4.34[95％CI：1.96-9.6]；P<0.001和OR：1.22[95％CI：1.03-1.12]；P=0.015，分别）。与无预处理相比，抗促性腺激素预处理降低了OMR<75％的风险（OR：0.72[95％CI：0.57-0.91]；P=0.02）。
结论：我们的研究受到回顾性设计和排除hCG再触发者的限制。然而,这只发生在六个周期中。我们也无法收集有关预处理持续时间和冲洗期持续时间的信息。
结论：在临床实践中，为了避免糟糕的ORR，在BMI较高和/或卵巢储备较低的患者中，不应仅考虑GnRHa触发。与卵巢过度刺激综合征的风险平衡。在低的12小时后触发LH水平的情况下，执业医师必须意识到ORR不良的风险，可以考虑重新触发hCG。
背景：无。
背景：不适用。
