IVF Treatment in Women With Immature Oocytes in Previous Cycle
Condition: Infertility
MeSH terms: Infertility
Study type: Interventional

Summary: 
      In standard IVF stimulation cycle,human chorionic gonadotropin (hCG) is usually used at the
      end of controlled ovarian hyperstimulation (COH) as a surrogate to only the luteinizing
      hormone (LH) surge. Yet, the last dose of follicle stimulating hormone (FSH) is usually given
      between 12-24 hours before the hCG triggering dose.One protocol used at the investigators
      unit, after a cycle with low proportion of mature oocytes per number oocytes retrieved, is
      triggering with high dose hCG (500 mcg)-38 hours prior to oocyte aspiration.

      Lately, new researches showed that dual triggering of final oocyte maturation with a
      combination of GnRH- agonist and hCG, could improve the live-birth rate of normal responders
      undergoing the GnRH-antagonist COH protocol

      Another treatment option is high dose hCG. Only few case reports have described the use of
      high dose hCG after aspiration of non mature oocytes at a previous cycle. At the
      investigators IVF unit, patients with previous history of high percentage of immature oocytes
      retrieved, are triggered at the following cycle, either with double trigger or with high dose
      of hCG decided by the physician consulting the patient. It is still not known with which way
      of triggering more mature oocytes is retrieved.

      The aim of this study is to perform a prospective randomized controlled study in patients
      with low proportion of mature-MII oocytes oocytes (<75%) per number oocytes retrieved,
      despite normal response to controlled ovarian hyperstimulation ( COH ) comparing cycles
      triggered with high dose hCG to those triggered with hCG+GnRH agonist.
    

Detailed description: 
      Patients will be prospectively randomized into two groups. The randomization will be
      organized through the computer. The hCG group- will be triggered for final follicular
      maturation with high dose hCG (500 mcg)-38 hours prior to oocyte aspiration, and the Double
      trigger Group- will receive gonadotropin-releasing hormone (GnRH) agonist (Decapeptyl 0.2mg)
      40 hours prior to oocyte aspiration and hCG (250mcg) 34 hours prior to the oocyte aspiration.
      All patients will be supplemented with the same progesterone preparation( Crinone gel 8% once
      a day) for luteal support. Women that suffer from vaginal spotting or vaginal bleeding during
      the luteal phase will receive supplementation of Geston 50MG intramuscular once every 2 days.

      At the day of oocyte aspiration, blood will be drawn for serum LH, FSH, estrogen (E2) and
      progesterone. Moreover, clear follicular fluid will be collected and tested for LH, FSH, E2
      and progesterone levels.
    

Intervention name(s): GnRH agonist 0.2 mg + hCG 250 mcg; high dose hCG 500 mcg
Intervention type(s): Drug; Drug
Intervention description(s): Treatment for triggering; Treatment for triggering
Other intervention name(s): GnRH agonist - Decapeptyl , hCG - Ovitrelle; Ovitrelle
Intervention MeSH terms: Triptorelin Pamoate; Chorionic Gonadotropin
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: double triggering; Oocyte maturation; GNRH Agonist; hCG; IVF treatment; immature oocytes